{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:00:13Z","timestamp":1787238013360,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,8,21]],"date-time":"2021-08-21T00:00:00Z","timestamp":1629504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001605","name":"Epilepsy Foundation","doi-asserted-by":"publisher","award":["EF\u2010 213583"],"award-info":[{"award-number":["EF\u2010 213583"]}],"id":[{"id":"10.13039\/100001605","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010621","name":"Pediatric Epilepsy Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010621","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study was undertaken to evaluate benzodiazepine (BZD) administration patterns before transitioning to non\u2010BZD antiseizure medication (ASM) in pediatric patients with refractory convulsive status epilepticus (rSE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter study in the United States and Canada used prospectively collected observational data from children admitted with rSE between 2011 and 2020. Outcome variables were the number of BZDs given before the first non\u2010BZD ASM, and the number of BZDs administered after 30 and 45\u00a0min from seizure onset and before escalating to non\u2010BZD ASM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 293 patients with a median (interquartile range) age of 3.8 (1.3\u20139.3) years. Thirty\u2010six percent received more than two BZDs before escalating, and the later the treatment initiation was after seizure onset, the less likely patients were to receive multiple BZD doses before transitioning (incidence rate ratio [IRR]\u00a0=\u00a0.998, 95% confidence interval [CI] = .997\u2013.999 per minute,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.01). Patients received BZDs beyond 30 and 45\u00a0min in 57.3% and 44.0% of cases, respectively. Patients with out\u2010of\u2010hospital seizure onset were more likely to receive more doses of BZDs beyond 30\u00a0min (IRR\u00a0=\u00a02.43, 95% CI = 1.73\u20133.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.0001) and beyond 45\u00a0min (IRR\u00a0=\u00a03.75, 95% CI\u00a0=\u00a02.40\u20136.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.0001) compared to patients with in\u2010hospital seizure onset. Intermittent SE was a risk factor for more BZDs administered beyond 45\u00a0min compared to continuous SE (IRR\u00a0=\u00a01.44, 95% CI = 1.01\u20132.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.04). Forty\u2010seven percent of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a094) with out\u2010of\u2010hospital onset did not receive treatment before hospital arrival. Among patients with out\u2010of\u2010hospital onset who received at least two BZDs before hospital arrival (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a054), 48.1% received additional BZDs at hospital arrival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Failure to escalate from BZDs to non\u2010BZD ASMs occurs mainly in out\u2010of\u2010hospital rSE onset. Delays in the implementation of medical guidelines may be reduced by initiating treatment before hospital arrival and facilitating a transition to non\u2010BZD ASMs after two BZD doses during handoffs between prehospital and in\u2010hospital settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17043","type":"journal-article","created":{"date-parts":[[2021,8,21]],"date-time":"2021-08-21T15:24:29Z","timestamp":1629559469000},"page":"2766-2777","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Benzodiazepine administration patterns before escalation to second\u2010line medications in pediatric refractory convulsive status epilepticus"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8059-9388","authenticated-orcid":false,"given":"Theodore","family":"Sheehan","sequence":"first","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children\u2019s Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-3495","authenticated-orcid":false,"given":"Marta","family":"Amengual\u2010Gual","sequence":"additional","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children\u2019s Hospital Harvard Medical School Boston Massachusetts USA"},{"name":"Pediatric Neurology Unit Department of Pediatrics Son Espases University Hospital University of the Balearic Islands Palma Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Vasquez","sequence":"additional","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children\u2019s Hospital Harvard Medical School Boston Massachusetts USA"},{"name":"Division of Child and Adolescent Neurology Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6166-2663","authenticated-orcid":false,"given":"Nicholas S.","family":"Abend","sequence":"additional","affiliation":[{"name":"Division of Neurology Children\u2019s Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Anderson","sequence":"additional","affiliation":[{"name":"Section of Neurology and Developmental Neuroscience Department of Pediatrics Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Appavu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children\u2019s Hospital Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-9718","authenticated-orcid":false,"given":"Ravindra","family":"Arya","sequence":"additional","affiliation":[{"name":"Division of Neurology Cincinnati Children's Hospital Medical Center University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4719-6683","authenticated-orcid":false,"given":"Cristina","family":"Barcia Aguilar","sequence":"additional","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children\u2019s Hospital Harvard Medical School Boston Massachusetts USA"},{"name":"Department of Child Neurology La Paz University Hospital Autonomous University of Madrid Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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