Midazolam and diazepam for pediatric seizures in the prehospital setting

Craig Warden, Carrie Frederick

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective. The objective of this study was to compare the efficacy and adverse events associated with the use of diazepam and midazolam for the treatment of pediatric seizures in the prehospital setting. Methods. This was a retrospective cohort study of all patients younger than 18 years treated for a seizure with a benzodiazepine by emergency medical services in Multnomah County, Oregon, from 1998 to 2001. The emergency medical services system consists of a single private advanced life support transporting ambulance service with fire department first responders that are all advanced life support capable. The benzodiazepine used changed from diazepam to midazolam at the midpoint of this period. The primary outcomes were termination of the seizure by arrival to the emergency department (ED), recurrence of seizure while in the ED, or the requirement for active airway interventions including intubation. The two cohorts were also compared for demographics, past history of seizures, long-term use of seizure medications, response times, route of administration, use of second doses of benzodiazepines, and final disposition. Results. Forty-five patients were treated with diazepam, and 48 were treated with midazolam. The two cohorts were comparable except the diazepam cohort had a significantly increased proportion of patients with previous afebrile seizures (53% vs. 25%; p = 0.005). The midazolam cohort had an increased use of nonintravenous route for initial dosing (65% vs. 42%; p = 0.02). The two cohorts were equivalent in rates of termination of seizures before to ED arrival, recurrence of seizures in the ED, requiring airway support or a second dose of benzodiazepine, and admission to the hospital. Conclusions. Diazepam and midazolam appear to be equivalent in treating seizures and causing adverse events. Paramedics appear to be administering midazolam intramuscularly more often than they use diazepam rectally.

Original languageEnglish (US)
Pages (from-to)463-467
Number of pages5
JournalPrehospital Emergency Care
Volume10
Issue number4
DOIs
StatePublished - Dec 1 2006

Fingerprint

Midazolam
Diazepam
Seizures
Pediatrics
Benzodiazepines
Hospital Emergency Service
Emergency Medical Services
Recurrence
Allied Health Personnel
Ambulances
Intubation
Reaction Time
Cohort Studies
Retrospective Studies
Demography

Keywords

  • Diazepam
  • Midazolam
  • Pediatric
  • Seizures

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Midazolam and diazepam for pediatric seizures in the prehospital setting. / Warden, Craig; Frederick, Carrie.

In: Prehospital Emergency Care, Vol. 10, No. 4, 01.12.2006, p. 463-467.

Research output: Contribution to journalArticle

@article{eb7809a438fb40aaa2b10eb394e16a13,
title = "Midazolam and diazepam for pediatric seizures in the prehospital setting",
abstract = "Objective. The objective of this study was to compare the efficacy and adverse events associated with the use of diazepam and midazolam for the treatment of pediatric seizures in the prehospital setting. Methods. This was a retrospective cohort study of all patients younger than 18 years treated for a seizure with a benzodiazepine by emergency medical services in Multnomah County, Oregon, from 1998 to 2001. The emergency medical services system consists of a single private advanced life support transporting ambulance service with fire department first responders that are all advanced life support capable. The benzodiazepine used changed from diazepam to midazolam at the midpoint of this period. The primary outcomes were termination of the seizure by arrival to the emergency department (ED), recurrence of seizure while in the ED, or the requirement for active airway interventions including intubation. The two cohorts were also compared for demographics, past history of seizures, long-term use of seizure medications, response times, route of administration, use of second doses of benzodiazepines, and final disposition. Results. Forty-five patients were treated with diazepam, and 48 were treated with midazolam. The two cohorts were comparable except the diazepam cohort had a significantly increased proportion of patients with previous afebrile seizures (53{\%} vs. 25{\%}; p = 0.005). The midazolam cohort had an increased use of nonintravenous route for initial dosing (65{\%} vs. 42{\%}; p = 0.02). The two cohorts were equivalent in rates of termination of seizures before to ED arrival, recurrence of seizures in the ED, requiring airway support or a second dose of benzodiazepine, and admission to the hospital. Conclusions. Diazepam and midazolam appear to be equivalent in treating seizures and causing adverse events. Paramedics appear to be administering midazolam intramuscularly more often than they use diazepam rectally.",
keywords = "Diazepam, Midazolam, Pediatric, Seizures",
author = "Craig Warden and Carrie Frederick",
year = "2006",
month = "12",
day = "1",
doi = "10.1080/10903120600885126",
language = "English (US)",
volume = "10",
pages = "463--467",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",
number = "4",

}

TY - JOUR

T1 - Midazolam and diazepam for pediatric seizures in the prehospital setting

AU - Warden, Craig

AU - Frederick, Carrie

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Objective. The objective of this study was to compare the efficacy and adverse events associated with the use of diazepam and midazolam for the treatment of pediatric seizures in the prehospital setting. Methods. This was a retrospective cohort study of all patients younger than 18 years treated for a seizure with a benzodiazepine by emergency medical services in Multnomah County, Oregon, from 1998 to 2001. The emergency medical services system consists of a single private advanced life support transporting ambulance service with fire department first responders that are all advanced life support capable. The benzodiazepine used changed from diazepam to midazolam at the midpoint of this period. The primary outcomes were termination of the seizure by arrival to the emergency department (ED), recurrence of seizure while in the ED, or the requirement for active airway interventions including intubation. The two cohorts were also compared for demographics, past history of seizures, long-term use of seizure medications, response times, route of administration, use of second doses of benzodiazepines, and final disposition. Results. Forty-five patients were treated with diazepam, and 48 were treated with midazolam. The two cohorts were comparable except the diazepam cohort had a significantly increased proportion of patients with previous afebrile seizures (53% vs. 25%; p = 0.005). The midazolam cohort had an increased use of nonintravenous route for initial dosing (65% vs. 42%; p = 0.02). The two cohorts were equivalent in rates of termination of seizures before to ED arrival, recurrence of seizures in the ED, requiring airway support or a second dose of benzodiazepine, and admission to the hospital. Conclusions. Diazepam and midazolam appear to be equivalent in treating seizures and causing adverse events. Paramedics appear to be administering midazolam intramuscularly more often than they use diazepam rectally.

AB - Objective. The objective of this study was to compare the efficacy and adverse events associated with the use of diazepam and midazolam for the treatment of pediatric seizures in the prehospital setting. Methods. This was a retrospective cohort study of all patients younger than 18 years treated for a seizure with a benzodiazepine by emergency medical services in Multnomah County, Oregon, from 1998 to 2001. The emergency medical services system consists of a single private advanced life support transporting ambulance service with fire department first responders that are all advanced life support capable. The benzodiazepine used changed from diazepam to midazolam at the midpoint of this period. The primary outcomes were termination of the seizure by arrival to the emergency department (ED), recurrence of seizure while in the ED, or the requirement for active airway interventions including intubation. The two cohorts were also compared for demographics, past history of seizures, long-term use of seizure medications, response times, route of administration, use of second doses of benzodiazepines, and final disposition. Results. Forty-five patients were treated with diazepam, and 48 were treated with midazolam. The two cohorts were comparable except the diazepam cohort had a significantly increased proportion of patients with previous afebrile seizures (53% vs. 25%; p = 0.005). The midazolam cohort had an increased use of nonintravenous route for initial dosing (65% vs. 42%; p = 0.02). The two cohorts were equivalent in rates of termination of seizures before to ED arrival, recurrence of seizures in the ED, requiring airway support or a second dose of benzodiazepine, and admission to the hospital. Conclusions. Diazepam and midazolam appear to be equivalent in treating seizures and causing adverse events. Paramedics appear to be administering midazolam intramuscularly more often than they use diazepam rectally.

KW - Diazepam

KW - Midazolam

KW - Pediatric

KW - Seizures

UR - http://www.scopus.com/inward/record.url?scp=33749023889&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33749023889&partnerID=8YFLogxK

U2 - 10.1080/10903120600885126

DO - 10.1080/10903120600885126

M3 - Article

VL - 10

SP - 463

EP - 467

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

IS - 4

ER -