EFFECT OF PREHOSPITAL TREATMENT ON THE OUTCOME OF STATUS EPILEPTICUS IN CHILDREN

Diazepam is administered to children in status epilepticus by paramedi cs in many Emergency Medical Services systems throughout the United St ates despite the lack of clear evidence that this therapy is safe and effective when employed in the prehospital environment. We reviewed th e clinical course of 45 episodes of generalized convulsive status epil epticus (SE) in 38 children to determine the effect of prehospital dia zepam therapy (given rectally or intravenously) on the clinical course of SE and subsequent patient management. Nineteen SE episodes were tr eated with prehospital diazepam therapy-9 episodes with rectal diazepa m (mean dose: 0.6 mg/kg) and 10 episodes with intravenous diazepam (me an dose: 0.2 mg/kg). Prehospital diazepam therapy was associated with SE of shorter duration (32 min vs 60 min; P = .007) and a reduced like lihood of recurrent seizures in the emergency department (58% vs 85%; P = .045). There were no significant differences between rectal and in travenous diazepam therapy with regard to SE duration, intubation, or recurrent seizures in the emergency department. These data suggest tha t prehospital administration of diazepam may shorten the duration of S E in children and simplify the subsequent management of these patients in the emergency department.