Background

Prolonged seizures (PS) in children carry significant risk of morbidity and mortality.^1,2 Previous work has predominantly focused on status epilepticus ≥30min but a new ILAE definition has been produced following evidence that seizures ≥5min are associated with negative outcomes.³ There has been increasing effort by clinicians and epilepsy specialist nurses to manage PS effectively through benzodiazepines, education and training.⁴ This study aims to provide population-based data on children presenting with PS and their outcomes.

Methods

All children presenting to accident and emergency (A+E) between 2011-2017 from a Scottish Children’s hospital were identified (capture-recapture method with multiple datasets). Data was collated from electronic health records; including patient demographics, clinical characteristics, acute seizure management and outcomes. This data can be used to study long-term outcomes, including educational outcome, through national data linkage systems.

Results

There were 666 children (1234 seizure episodes). These accounted for 0.38% (95% CI (0.34-0.42%)) of A+E admissions. Age (figure 1), seizure duration (figure 2) and select patient demographics are displayed (table 1). PS incidence increased at the extremes of socioeconomic status and relationship with distance from A+E can be determined. Seizure duration, mortality and requirement for ventilatory support decreased compared to historical data. There was a lower likelihood of hospital admission where buccal midazolam was administered.

Conclusions

Adverse outcomes have decreased and the use of buccal midazolam is promising. Identifying high-risk groups provides opportunity for early intervention. This data forms the basis for extensive evaluation of acute seizure management and monitoring long-term outcomes.