Clinical Guidelines in Acute Seizure Management

1
Clinical Guidelines in Acute Seizure Management

• William C. Dalsey, MD, FACEP, MBA
• Department of Emergency Medicine
• Robert Wood Johnson University Hospital
• New Jersey
• sparkledmd_at_aol.com
• 215-654-1190

2
How Do You Begin to Create a Clinical Guideline
for Seizures?

• Selecting the Topic
• Selecting Members of the Committee
• Process for Evaluating the Literature
• Process to Create Clinical Guideline

3
Critical Questions

• How do you evaluate and treat a seizure patient?
• Complicating Factors
• Status Epilepticus
• Hypoglycemia
• Febrile Seizures
• Alcohol Withdrawal
• Trauma
• Eclampsia

4
What is best?

• Efficacy of Treatment?
• Safety?
• Complications? Side Effects?
• Route of Administration?
• Costs?
• Society/Ethics?

5
Are There Existing Practice Guidelines?

• www.guidelines.gov
• AMA Clinical Guidelines Clearinghouse
• Cochrane Library

6
Asking the Right Questions

• The need to be specific
• Identification of inclusion/exclusion criteria
• Searching the Literature
• Metanalysis and Nonrandomized Trials