(952) Impact of Benzodiazepine and Antiseizure Medication Dosing in Status Epilepticus

Introduction: Status epilepticus (SE) is associated with serious morbidity and mortality, necessitating prompt and effective treatment. Rate of achieving weight-based, guideline-recommended benzodiazepine (BZD) and antiseizure medication (ASM) doses for SE has been previously reported as low; however, the impact of dosing on patient outcomes is unclear. This study aimed to examine the current rate of adequate dosing of BZDs and ASMs for SE and if adequate first-doses of ASMs positively impacted patient outcomes.

Methods: This was a multi-center, retrospective cohort study of patients with SE who received BZD therapy pre- or in-hospital. The primary outcome was rate of adequate BZD first-dose and adequate ASM first-dose, as defined by Neurocritical Care Society guideline-recommended dosing. ASM doses were also counted as adequate if the patient was taking the medication prior to presentation. The primary outcome was broken down into its components of adequate BZD first-dose or adequate ASM first-dose as secondary outcomes. Additional secondary outcomes included change in functional status among those who lived independently prior to admission, intensive care unit (ICU) length of stay, hospital length of stay, all-cause in-hospital mortality, and rates of seizure cessation after each line of therapy, defined as surviving to hospital discharge without receiving the next line of therapy.

Results: Of the 418 encounters identified, 112 were excluded, leaving 305 patient encounters in the dosing analysis. Outcomes data were available for 284 included patient encounters. The primary outcome occurred in 3 patient encounters (1%). An adequate BZD first-dose was given in 11 patient encounters (3.6%) and an adequate ASM first-dose was given in 114 patient encounters (37.4%). All-cause in-hospital mortality was lower in the adequate compared to the inadequate ASM dosing group (6.4% vs 16%; p=0.016). Decline in functional status, median ICU length of stay, median hospital length of stay, and seizure cessation were similar among the two groups.

Conclusions: Rates of adequate first-doses of BZDs and ASMs were low, and adequate ASM first-doses were associated with a trend toward functional status benefit and mortality benefit which warrants further exploration with prospective studies.