Objective:

Our objective is to assess the comfort, perceptions, and management practices of adult emergency medicine providers in Kentucky regarding pediatric status epilepticus (SE), and to identify the need for education and the development of standardized pathways.

Background:

Pediatric SE is a medical emergency that occurs in ~20 per 100,000 Kentucky children annually. Nearly 89% of children nationwide present first to adult emergency departments (EDs), where providers may have limited pediatric-specific training and resources. Evidence-based pathways can improve care by standardizing antiepileptic drug (AED) selection, dosing, and administration for SE, but have not been well-studied for pediatric patients presenting to adult EDs.

Design/Methods:

We distributed a survey to adult ED providers in Kentucky to determine if their EDs utilize a pediatric SE algorithm, and to assess provider comfort with SE management topics, including AED selection, dosing, timing, escalation, and referral (via rank choice and Likert scale). A SE management pathway was subsequently distributed, with post-intervention reassessment ongoing.

Results:

Forty-four providers from 20 unique Kentucky adult EDs completed the survey. Only three respondents (6.8%) reported an existing pediatric SE algorithm at their institution; fourteen (31.8%) were unsure if one existed, and most respondents (86.4%) would use an algorithm if provided. Regarding provider comfort, only 14 (31.8%) chose AED timing, 15 (34.1%) AED dosing, and 17 (38.6%) decision to escalate therapy, and the highest comfort with AED selection (65.9%) and decisions to refer (72.7%). 

Conclusions:

We identify significant gaps in readiness for pediatric SE among adult EDs, with few EDs utilizing standardized treatment algorithms. While providers were relatively confident in management, standardized protocols and targeted education may improve specific areas of weakness. Ongoing interventional studies assessing improvements in comfort and outcomes are planned and play a critical role in improving emergency care for children across Kentucky.