Factors Related to Delays in Pre-hospital Management of Status Epilepticus

Abstract

Introduction: This study was designed to identify factors related to delays in pre-hospital management of status epilepticus (SE). Methods: This retrospective study includes all adult (>16 years of age) patients (N = 82) diagnosed with established SE in the Helsinki University Central Hospital emergency department (ED) over 2 years. SE was defined as a clinically observed episode fulfilling one of the following criteria: (1) continuous seizure lasting over 30 min; (2) recurring seizures without return of consciousness between seizures; (3) occurrence of more than four seizures within any 1 h. We collected 15 variables related to SE type, patient, and SE episode from the medical records, defined and calculated six pre-hospital delay parameters and analyzed their relations using univariate analysis and multivariate linear regression models. Results: In the multivariate regression analysis, the focal SE was significantly associated with a long delay from SE onset to initial treatment (p < 0.05), to diagnosis (p < 0.002), and to anesthesia (p < 0.002). Administration of the initial treatment before emergency medical service arrived was significantly associated with long delay of the first alarm (p < 0.02) and arrival at the first ED (p < 0.04). Primary admission to a healthcare unit other than tertiary hospital caused a significant delay in diagnosis (p < 0.008) and anesthesia (p < 0.02). Surprisingly, univariate analysis revealed that if the SE onset occurred in a healthcare unit, the delays from SE onset to first alarm (p < 0.001), to arrival in first ED (p < 0.001), to arrival in tertiary hospital (p < 0.001), to diagnosis (p < 0.02), and to anesthesia (p < 0.01) were significantly longer than in cases in which SE onset occurred at a public place. Conclusion: We found remarkable inadequacy in recognition of SE both among laity and medical professionals. There is an obvious need for increasing awareness of imminent SE and optimizing the pre-hospital management of established SE. SE should be considered as a medical emergency comparable with stroke and cardiac infarction and be allocated with similar resources in the pre-hospital management.