Quality Improvement in time to Treatment of Status Epilepticus (QuITT-SE)

急性发作可能演变为癫痫持续状态(SE)，即持续或反复发作，而不是 恢复意识，导致不可逆转的脑损伤或死亡，每年给美国造成约40亿美元的损失 医疗保健系统。如果正确剂量的苯二氮卓类药物(BZD)迅速治疗癫痫，SE及其 可以避免相关的发病率和死亡率。例如，儿童在癫痫发作10分钟后接受治疗 发病患者在住院期间死亡的可能性是早期治疗患者的11倍。因此， 美国神经病学学会将治疗时间确定为评估SE护理的质量指标。尽管 这些循证建议，延迟癫痫治疗在许多中心仍然是现状。 及时治疗癫痫持续状态的质量改进(QUIT-SE)研究将审查 一套标准化的QI干预措施在具有多样性的儿科医院中的实施和效果 地理位置、患者人口统计和资源。建议的干预措施是在一个 单中心研究，在指导时间内治疗SE发作的数量翻了一番，降低了发病率， 并在接下来的17个月内减轻了200多万美元的费用。我们的首要目标是研究 这些QI干预措施的实施及其对跨多个中心SE治疗时间的影响 一种有效性-实施混合设计。QUIT-SE试验将是一个阶梯-楔形随机整群试验 在儿科癫痫持续状态研究组内的多个地点进行的试验，该研究组是一个由 在研究和治疗儿童SE方面具有专业知识的医院。在这个项目中，混合了定性和 将使用量化方法来确定与干预措施有关的执行因素。此外， 在实用、稳健的实施和可持续发展模式(PRISM)中使用标准化的QI流程 将促进确定与延迟SE治疗有关的特定地点的驱动因素和主题，改善 结论的概括性。 具体目标是：1)主要：确定实施QI捆绑包对治疗时间的影响 在住院的非危重儿童中发生了硒中毒。2)二期：确定对儿童大脑的影响 在实施QI捆绑后，住院的非危重儿童的表现类别得分。2B) 第二：确定传播QI捆绑包对SE住院费用的影响 住院的非危重儿童3)探索性：探索实施QI捆绑包所涉及的因素 住院儿童SE救治时机的探讨 对公共健康的影响：据估计，在美国，SE每年导致15,000-45,000名儿童死亡 成本约为40亿美元，随着癫痫发作时间的延长，成本显著增加。成功完成QUIT-SE 将产生一套以证据为基础的干预措施，同时制定一个执行框架，以改善结果 以及不同医院环境下SE治疗的价值。

Acute seizures may evolve into status epilepticus (SE), i.e., prolonged or repeated seizures without regaining consciousness, resulting in irreversible brain injury or death costing ~$4 billion annually to the US healthcare system. If seizures are treated rapidly with a correctly-dosed benzodiazepine (BZD), SE and its associated morbidity and mortality may be averted. For instance, children treated after 10 minutes of seizure onset are 11 times more likely to die during their hospitalization than patients treated earlier. Therefore, the American Academy of Neurology identified time to treatment as a quality metric to evaluate SE care. Despite these evidence-based recommendations, delayed seizure treatment remains the status quo in many centers. The Quality Improvement in Time to Treatment of Status Epilepticus (QuITT-SE) study will examine the implementation and effects of a standardized set of QI interventions across pediatric hospitals with diversity in geography, patient demographics and resources. The proposed interventions were developed and tested in a single-center study that doubled the number of SE episodes treated within guideline timing, decreased morbidity, and mitigated over $2 million of charges in the following 17-month period. Our overarching goal is to study the implementation of these QI interventions and their effect on time to SE treatment across multiple centers utilizing an effectiveness-implementation hybrid design. The QuITT-SE trial will be a stepped-wedge cluster randomized trial across multiple sites within the Pediatric Status Epilepticus Research Group, an established consortium of hospitals with expertise in studying and treating SE in children. During this project, mixed qualitative and quantitative methods will be used to identify implementation factors related to the interventions. In addition, the use of standardized QI processes within the Practical, Robust Implementation and Sustainability Model (PRISM) will facilitate the identification of site-specific drivers and themes pertaining to delayed SE treatment, improving the generalizability of findings. The specific aims are: 1) Primary: Determine how implementing a QI bundle impacts the time to treat SE among hospitalized, non-critically ill children. 2a) Secondary: Determine the effect on Pediatric Cerebral Performance Category score among hospitalized, non-critically ill children after implementing a QI bundle. 2b) Secondary: Determine the effect of dissemination of a QI bundle on cost of hospitalization for SE among hospitalized, non-critically ill children 3) Exploratory: Explore the factors implicated in implementing a QI bundle on the time to treat SE among hospitalized children. Public Health Impact: Each year, SE results in an estimated 15,000-45,000 deaths in children in the US and costs ~$4 billion, increasing markedly with more prolonged seizures. Successful completion of QuITT-SE will produce a set of evidence-based interventions alongside an implementation framework to improve outcomes and value of SE treatment across diverse hospital settings.