(664) Impact of Initial Benzodiazepine Dosing on Escalation of Therapy for Pediatric Status Epilepticus

Introduction: Clinical guidelines emphasize the need for rapid control of status epilepticus (SE) and prevention of recurrent seizures. The purpose of this retrospective chart review was to determine if administering lower than guideline recommended benzodiazepine doses increases the need to escalate therapy to terminate seizures in pediatric SE.

Methods: In a retrospective, single-center, cohort study, we compared the efficacy and safety of the American Epilepsy Society (AES) guideline recommended dosing of benzodiazepines to those that received lower doses for pediatric SE. The primary outcome was administration of an additional antiepileptic medication following the administration of the initial benzodiazepine. Efficacy outcomes included pediatric intensive care unit (PICU) admission, length of hospital stay, and length of PICU stay. Safety outcomes included respiratory support and discharge disposition. Patients were assigned to either the adequately dosed (AD) or underdosed (UD) group based on AES dosing recommendations with an allowable deviation of 10%.

Results: A total of 350 admissions were included in this study, representing 158 unique patients aged 2 months to 18 years old. A total of 158 patients were assigned to the AD group and 192 patients were assigned the UD group. The primary outcome occurred in 65 patients in the AD group (41.1%) and 67 patients in the UD group (34.9%) (P= .230). There was a statistically significant association with the age of the patient and assigned cohort, with older patients being more likely to be underdosed and younger patients being more likely to be adequately dosed (P <.001). There was no difference between groups in the number of patients who required an increase in respiratory support following initial benzodiazepine administration with 23 in the AD group and 25 in the UD group (P=.908).

Conclusions: This study did not show a difference in benzodiazepine dosing strategies and the need to escalate anti-epileptic therapy to terminate seizures for pediatric SE. Similar rates of respiratory support and discharge disposition were observed between both groups. Future studies are needed focusing on age to determine if there is a statistical difference in the outcomes of interest.