O1067 Oct.4: 4:42pm - Interhospital Transport of Children with Seizures or Status Epilepticus: A Single-center Experience

Background: Seizures are a common cause for hospitalizations in children, with status epilepticus (SE) being the most common pediatric neurologic emergency. We hypothesize that opportunities exist for improving transport and healthcare resource utilization for this patient population. We aimed to describe our institution’s experience with children transferred for seizures/SE and identify areas to focus transport-related quality improvement and education.
Methodology: Retrospective chart review of children aged ≤18 years transferred to Johns Hopkins for management of seizures/SE in 2019.

Discussion: 143 (4.3%) of 3,331 transferred children were referred for seizures/SE. Their mean age was 6.7 years (SD 5.6) and 78 (54.5%) were male. Fifty-eight (40.6%) were white, 57 (39.9%) African-American, and 15 (10.5%) Hispanic. More than half (79/143, 55.2%) had either a known seizure disorder, or prior history of seizure (unprovoked or febrile). A few (4/143, 2.8%) were chronically ventilated. Children were transported mostly by ground ambulance (135/143, 94.4% vs. 8/143, 5.6% by rotor-wing) from 35 different referring hospitals, whose median (IQR) distance from our center was 25 (9-45) miles, and mean pediatric readiness score was three. Patients’ disposition at our institution varied: 47 (32.9%) were discharged from the Pediatric ED after a median (IQR) observation period of 5.2 (3.2-7) hours, 55 (38.5%) were admitted to the ward, and 41 (28.7%) to the ICU.
Seizure in a patient with known epilepsy was the leading diagnosis for the entire cohort (53/143, 37.1%), as well as for the subgroups of children discharged from the ED or admitted to the ward/ICU. Diagnostic work-up most commonly included electroencephalogram (71/143, 49.7%), neuroimaging (53/143, 37.1% via brain MRI and 52/143, 36.4% via head CT), and lumbar puncture (22/143, 15.4%).
The most frequently performed procedure was intubation, which was required by 23/41 (56.1%) children in the ICU subgroup. Of these, 21 (91.3%) were performed by referring physicians pre-transport, while two (8.7%) were performed post-transport. Median (IQR) mechanical ventilation time at our institution was 10.2 (6.3-18.5) hours. None of the children admitted to the ward required ICU transfer, and only one (2.1%) of those discharged from the ED re-presented within 48 hours. Median (IQR) length-of-stay was 38.3 (23.0-73.6) hours in the ICU and 48 (26.6-86.4) hours in the hospital (for all hospitalized patients).

Conclusion: Children transferred for seizures/SE, mostly in the setting of known or newly diagnosed epilepsy, represent <5% of our transport volume. While most patients admitted to the ICU were intubated, they generally had brief durations of mechanical ventilation and short ICU stays. Nearly one third of transports were discharged from our pediatric ED post-transfer, suggesting opportunities for improved transport resource utilization, particularly via telehealth implementation.