OBJECTIVE Treatment delays for refractory convulsive status epilepticus (RCSE) are associated with worse outcomes. In the United States, treatment for pediatric RCSE is slower than guidelines recommend. To address this gap, the American Academy of Neurology and Child Neurology Society (AAN/CNS) developed a quality measure: the percentage of RCSE patients that receive third-line treatment within 60 minutes. We aimed to develop computable phenotypes for convulsive status epilepticus (CSE) and RCSE to automate calculation of the quality measure. METHODS From an observational cohort of children presenting to the emergency department for seizures or epilepsy, we identified presentations of RCSE and its precursors: CSE and benzodiazepine-resistant status epilepticus (BRSE). These served as a gold standard for computable phenotype development. Using multivariate analyses, we constructed and evaluated statistical models for case identification. We then evaluated adherence to the AAN/CNS RCSE quality measure. RESULTS From 664 charts, we identified 56 patients with CSE, 36 with BRSE, and 18 with RCSE. Four predictors were used: International Classification of Diseases (ICD) codes, and receiving first-, second-, or third-line agents shortly after presentation to the emergency department (ED). Combinations of these predictors identified CSE with 84% sensitivity and 81% positive predictive value (PPV), BRSE with 67% sensitivity and 89% PPV, and RCSE with 94% sensitivity and 85% PPV. Median (interquartile range [IQR]) time to treatment for first-line agent was 13 (5-27) minutes for CSE, second-line for BRSE was 24 (9.5-43.5) minutes, and third-line for RCSE was 52 (27-87) minutes. Sixty percent of RCSE patients received a third-line agent within 60 minutes of ED arrival. SIGNIFICANCE RCSE and its precursors can be identified automatically with high fidelity allowing automated calculation of time to treatment and the RCSE quality measure. This has the potential to facilitate quality improvement work and improve care for RCSE.

中文翻译：

---

小儿惊厥性癫痫持续状态的自动识别和质量测量

目的 难治性惊厥性癫痫持续状态 (RCSE) 的治疗延迟与更差的结果相关。在美国，儿科 RCSE 的治疗比指南推荐的要慢。为了弥补这一差距，美国神经病学学会和儿童神经病学学会 (AAN/CNS) 制定了一项质量衡量标准：在 60 分钟内接受三线治疗的 RCSE 患者的百分比。我们旨在为惊厥性癫痫持续状态 (CSE) 和 RCSE 开发可计算的表型，以自动计算质量度量。方法 从因癫痫发作或癫痫急诊科就诊的儿童观察队列中，我们确定了 RCSE 及其前体的表现：CSE 和苯二氮卓类抗癫痫持续状态 (BRSE)。这些是可计算表型发展的黄金标准。使用多变量分析，我们构建并评估了用于病例识别的统计模型。然后，我们评估了对 AAN/CNS RCSE 质量措施的遵守情况。结果 从 664 个图表中，我们确定了 56 名 CSE 患者、36 名 BRSE 患者和 18 名 RCSE 患者。使用了四个预测因子：国际疾病分类 (ICD) 代码，以及在向急诊科 (ED) 报告后不久接受一线、二线或三线药物。这些预测因子的组合确定了具有 84% 敏感性和 81% 阳性预测值 (PPV) 的 CSE，具有 67% 敏感性和 89% PPV 的 BRSE，以及具有 94% 敏感性和 85% PPV 的 RCSE。CSE 一线药物治疗的中位（四分位距 [IQR]）时间为 13 (5-27) 分钟，BRSE 二线药物治疗时间为 24 (9.5-43.5) 分钟，RCSE 三线药物治疗时间为 52 ( 27-87) 分钟。60% 的 RCSE 患者在到达 ED 后 60 分钟内接受了三线药物。意义 RCSE 及其前体可以高保真地自动识别，允许自动计算治疗时间和 RCSE 质量度量。这有可能促进质量改进工作并改善对 RCSE 的护理。