Considerations for Possibility of Anti-convulsants in Prehospital Stage

ABSTRACT

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.