Time to Treatment in Pediatric Convulsive Refractory Status Epilepticus: The Weekend Effect.
BACKGROUND: Time to treatment in pediatric refractory status epilepticus is delayed. We aimed to evaluate the influence of weekends and holidays on time to treatment of this pediatric emergency. METHODS: We performed a retrospective analysis of prospectively collected observational data of pediatric patients with refractory status epilepticus. RESULTS: We included 329 patients (56% males) with a median (p25 to p75) age of 3.8 (1.3 to 9) years. The median (p25 to p75) time to first BZD on weekdays and weekends/holidays was 20 (6.8 to 48.3) minutes versus 11 (5 to 35) minutes, P = 0.01; adjusted hazard ratio (HR) = 1.20 (95% confidence interval [CI]: 0.95 to 1.55), P = 0.12. The time to first non-BZD ASM was longer on weekdays than on weekends/holidays (68 [42.8 to 153.5] minutes versus 59 [27 to 120] minutes, P = 0.006; adjusted HR = 1.38 [95% CI: 1.08 to 1.76], P = 0.009). However, this difference was mainly driven by status epilepticus with in-hospital onset: among 108 patients, the time to first non-BZD ASM was longer during weekdays than during weekends/holidays (55.5 [28.8 to 103.5] minutes versus 28 [15.8 to 66.3] minutes, P = 0.003; adjusted HR = 1.65 [95% CI: 1.08 to 2.51], P = 0.01). CONCLUSIONS: The time to first non-BZD ASM in pediatric refractory status epilepticus is shorter on weekends/holidays than on weekdays, mainly driven by in-hospital onset status epilepticus. Data on what might be causing this difference may help tailor policies to improve medication application timing.
Barcia Aguilar, C; Amengual-Gual, M; Sánchez Fernández, I; Abend, NS; Anderson, A; Appavu, B; Arya, R; Brenton, JN; Carpenter, JL; Chapman, KE; Clark, J; Farias-Moeller, R; Gaillard, WD; Gaínza-Lein, M; Glauser, T; Goldstein, JL; Goodkin, HP; Guerriero, RM; Huh, L; Lai, Y-C; McDonough, TL; Mikati, MA; Morgan, LA; Novotny, EJ; Ostendorf, A; Payne, ET; Peariso, K; Piantino, J; Riviello, J; Sannagowdara, K; Sheehan, T; Sands, TT; Tasker, RC; Tchapyjnikov, D; Topjian, AA; Vasquez, A; Wainwright, MS; Wilfong, AA; Williams, K; Loddenkemper, T; pSERG,
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