(927) Evaluation of Cumulative Doses of Intravenous Lorazepam for the Management of Status Epilepticus

Introduction: Status epilepticus (SE) is a medical emergency with high morbidity and mortality. Two separate guidelines recommend seizure control to be obtained within 60 minutes of seizure onset using benzodiazepines as first line agents. Despite guideline recommendations, multiple studies have determined that initial benzodiazepine doses are frequently underdosed. The purpose of this study is to assess the outcomes of adequate cumulative doses of benzodiazepines within 15-minute of hospital arrival and its effects on obtaining seizure control within 60 minutes of hospital arrival.

Methods: This single-center retrospective cohort study was conducted at a level 1 trauma center. We included adult patients weighing ≥ 40 kg who received IV lorazepam in the emergency department for the management of SE. Patients were divided into two cohorts, those who received cumulative doses of ≥ 4 mg or < 4mg lorazepam within 15 minutes of hospital arrival. The primary endpoint was the proportion of patients who achieved seizure control within 60 minutes of hospital arrival. Secondary endpoints for this study included proportion of patients who received a benzodiazepine dose prior to arrival (PTA), mechanical ventilation, hospital length of stay (LOS), ICU LOS, and in-hospital mortality.

Results: A total of 190 patients were included in the study (33 patients in ≥ 4mg lorazepam group and 157 patients in < 4mg lorazepam group). Seizure control within 60 minutes of hospital arrival was obtained in 78.8% of patients in the ≥ 4mg lorazepam group and 22.9% in the < 4mg of lorazepam group unadjusted OR 12.5, 95% (5.0-31.1), p= < 0.001 and adjusted OR 15.2, 95% (5.8-40.2) p= < 0.001. The average cumulative lorazepam dose administered within 15 minutes of hospital arrival was 5 mg ± 1.1 mg in the ≥ 4mg lorazepam group versus 1.8mg ± 0.5 mg in the < 4mg lorazepam group, p= < 0.001. Patients who received ≥ 4mg lorazepam were more likely to require hospital and ICU admission. There were no statistically significant differences in rates of mechanical intubation, administration of benzodiazepines PTA or in-hospital mortality.

Conclusions: Patients who received cumulative doses of ≥ 4mg lorazepam within 15 minutes hospital arrival for the management of SE were more likely to achieve seizure control within 60 minutes of hospital arrival.