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Prehospital benzodiazepine use and need for respiratory support in paediatric seizures
  1. Christina K Pfeiffer1,2,
  2. Karen Smith3,4,
  3. Stephen Bernard4,5,
  4. Stuart R Dalziel6,7,
  5. Stephen Hearps1,
  6. Tobias Geis2,
  7. Michael Kabesch2,
  8. Franz E Babl1,6,8,9
  9. On behalf of the PREDICT Network
  1. 1 Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  2. 2 Wissenschafts- und Entwicklungscampus Regensburg, University Children's Hospital Regensburg (KUNO-Clinics) at St Hedwig Hospital of the order of St John, Regensburg, Germany
  3. 3 Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
  4. 4 Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  5. 5 Ambulance Victoria, Doncaster, Victoria, Australia
  6. 6 Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia
  7. 7 Departments of Surgery and Paediatrics, The University of Auckland, Auckland, New Zealand
  8. 8 Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
  9. 9 Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Professor Franz E Babl, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; franz.babl{at}


Background Paramedics are frequently called to attend seizures in children. High-quality evidence on second-line treatment of benzodiazepine (BZD)-refractory convulsions with parenteral long-acting antiepileptic drugs in children has become available from the ED. In order to address the potential need for an alternative agent, we set out to determine the association of BZD use prehospital and the need for respiratory support.

Methods We conducted a retrospective observational study of state-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population: 6.5 million). Children aged 0–17 years assessed for seizures by paramedics were analysed for demographics, process factors, treatment and airway management. We calculated adjusted ORs (AOR) of the requirement for respiratory support in relation to the number of BZD doses administered.

Results Paramedics attended 5112 children with suspected seizures over 1 year (1 July 2018 to 30 June 2019). Overall, need for respiratory support was low (n=166; 3.2%). Before ambulance arrival, 509 (10.0%) had already received a BZD and 420 (8.2%) were treated with midazolam by paramedics. Of the 846 (16.5%) patients treated with BZD, 597 (70.6%) received 1 BZD dose, 156 (18.4%) 2 doses and 93 (11.0%) >2 doses of BZD. Patients who were administered 1, 2 and >2 doses of BZD received respiratory support in 8.9%, 32.1% (AOR 4.6 vs 1 dose, 95% CI 2.9 to 7.4) and 49.5% (AOR 10.3 vs 1 dose, 95% CI 6.0 to 17.9), respectively.

Conclusions Increasing administration of BZD doses was associated with higher use of respiratory support. Alternative prehospital antiepileptic drugs to minimise respiratory depression should be investigated in future research.

  • respiratory

Data availability statement

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Data availability statement

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  • Handling editor Shammi L Ramlakhan

  • Correction notice Since this article was first published online, figures 1 and 2 have been replaced to include updated abbreviations.

  • Contributors Study concept and design: FEB, KS, SRD, CKP. Acquisition of data: KS, SB, FEB, CKP. Analysis and interpretation of data: CKP, KS, SH, FEB. Drafting of the manuscript: CKP, FEB, KS. Critical revision of the manuscript for important intellectual content: CKP, KS, SB, SRD, TG, MK, FEB. Statistical expertise: SH. Acquisition of funding: FEB, KS. FEB is responsible for the overall content as the guarantor and accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The study was in part funded by a grant from the National Health and Medical Research Council (NHMRC) (Centre of Research Excellence for Paediatric Emergency Medicine GNT1058560), Canberra, Australia, and supported by the Victorian Government’s Infrastructure Support Program, Melbourne, Australia. FEB’s time was part funded by an NHMRC Practitioner Fellowship, Canberra, Australia, and a Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia. SRD’s time was part funded by the Health Research Council of New Zealand (HRC13/556) and Cure Kids New Zealand.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.