Key result
Only ~5% of physicians complete ABCDE assessments in simulated status epilepticus.
Why the study?
Respiratory infections following status epilepticus are frequent and linked to worse outcomes, with lack of airway protection potentially contributing to these complications.
Does adherence to the ABCDE approach improve treatment steps and airway protection in simulated status epilepticus?
Does adherence to the ABCDE approach improve treatment steps and airway protection in simulated status epilepticus?
Adherence to the ABCDE approach in simulated status epilepticus is infrequent, but when followed, it improves adherence to treatment steps and airway protection.
Infrequent ABCDE adherence in simulated SE highlights training needs; leaves open whether systematic checks reduce real-world post-SE respiratory infections.
Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.
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Kliem et al. (2022) studied Status Epilepticus (n=74). ABCDE approach adherence was evaluated on Number of ABCDE checks performed (regression coefficient -0.49, p=0.015). In a simulated status epilepticus scenario, only 5% of 74 physicians performed a complete ABCDE assessment, and neurologic affiliation was associated with fewer checks performed (p=0.015).
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