{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:49:30Z","timestamp":1787014170637,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["U1IMC43532"],"award-info":[{"award-number":["U1IMC43532"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["U1IMC45814"],"award-info":[{"award-number":["U1IMC45814"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>National guidelines in the United States recommend the intramuscular and intranasal routes for midazolam for the management of seizures in the prehospital setting. We evaluated the association of route of midazolam administration with the use of additional benzodiazepine doses for children with seizures cared for by emergency medical services (EMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study from a US multiagency EMS dataset for the years 2018\u20132022, including children transported to the hospital with a clinician impression of seizures, convulsions, or status epilepticus, and who received an initial correct weight\u2010based dose of midazolam (.2\u2009mg\/kg intramuscular, .1\u2009mg\/kg intravenous, .2\u2009mg\/kg intranasal). We evaluated the association of route of initial midazolam administration with provision of additional benzodiazepine dose in logistic regression models adjusted for age, vital signs, pulse oximetry, level of consciousness, and time spent with the patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 2923 encounters with patients who received an appropriate weight\u2010based dose of midazolam for seizures (46.3% intramuscular, 21.8% intranasal, 31.9% intravenous). The median time to the first dose of midazolam from EMS arrival was similar between children who received intramuscular (7.3\u2009min, interquartile range [IQR] =\u20094.6\u201312.5) and intranasal midazolam (7.8\u2009min, IQR\u2009=\u20094.5\u201313.4) and longer for intravenous midazolam (13.1\u2009min, IQR\u2009=\u20098.2\u201319.4). At least one additional dose of midazolam was given to 21.4%. In multivariable models, intranasal midazolam was associated with higher odds (odds ratio [OR] =\u20091.39, 95% confidence interval [CI] =\u20091.10\u20131.76) and intravenous midazolam was associated with similar odds (OR\u2009=\u20091.00, 95% CI = .80\u20131.26) of requiring additional doses of benzodiazepines relative to intramuscular midazolam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Intranasal midazolam was associated with greater odds of repeated benzodiazepine dosing relative to initial intramuscular administration, but confounding factors could have affected this finding. Further study of the dosing and\/or the prioritization of the intranasal route for pediatric seizures by EMS clinicians is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17940","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T10:57:59Z","timestamp":1710241079000},"page":"1294-1303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of midazolam route of administration and need for recurrent dosing among children with seizures cared for by emergency medical services"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-5726","authenticated-orcid":false,"given":"Sriram","family":"Ramgopal","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Owusu\u2010Ansah","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remle P.","family":"Crowe","sequence":"additional","affiliation":[{"name":"ESO  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Okubo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Martin\u2010Gill","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.09.019"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2023.02.023"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.4382"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3181fc4088"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.12.32066"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002029"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12905"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107494"},{"key":"e_1_2_14_10_1","unstructured":"National Association of State EMSO.Model EMS clinical guidelines.2022."},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3180328c92"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2021.1897197"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp140630"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2010.130"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-061223"},{"key":"e_1_2_14_16_1","first-page":"1","article-title":"Dosing errors made by paramedics during pediatric patient simulations after implementation of a state\u2010wide pediatric drug dosing reference","volume":"24","author":"Hoyle JD","year":"2019","journal-title":"Prehosp Emerg Care"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2016.1139217"},{"key":"e_1_2_14_18_1","first-page":"1","article-title":"An analysis of prehospital pediatric medication dosing errors after implementation of a state\u2010wide EMS pediatric drug dosing reference","volume":"28","author":"Kazi R","year":"2023","journal-title":"Prehosp Emerg Care"},{"key":"e_1_2_14_19_1","unstructured":"US Department of Transporation National Highway Traffic Safety Administration.National EMS scope of practice model 2019: including change notices 1.0 and 2.0.2021."},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2013.844874"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023216"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v045.i03"},{"key":"e_1_2_14_23_1","unstructured":"HarrellFEJr.rms: regression modeling strategies. 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