Brain & development · 2026
Effect of Doctor Car dispatch on neurological outcomes in children with status epilepticus: A single-Center retrospective cohort study.
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Kaneko Naoki, Yamazaki Tsutomu, Fukushima Ryosuke, Iimuro Satoshi, Akasaka Osamu
Аннотация
BACKGROUND: Status epilepticus (SE) requires prompt treatment because prolonged seizures increase the risk of neurological injury. We investigated whether a physician-staffed ambulance (commonly referred to as "Doctor Car" in Japan) improves neurological outcomes in pediatric SE.
METHODS: We conducted a medical record-based retrospective study of children aged ≤15 years with SE transported to a tertiary emergency center between December 2014 and November 2024. The primary endpoint was neurological sequelae at hospital discharge. Secondary endpoints included time to antiseizure medications (ASMs) administration, seizure duration, seizure cessation within the International League Against Epilepsy (ILAE) t2 threshold, and mechanical ventilation. Propensity score matching, subgroup analysis according to the t2 threshold, and Bonferroni correction were performed.
RESULTS: Twenty-one patients in the Doctor Car group and 127 in the non-Doctor Car group were analyzed, with 17 matched pairs. Doctor Car dispatch was associated with shorter time to ASMs administration and shorter seizure duration before and after propensity score matching. Patients whose seizures ceased within the ILAE t2 threshold were more likely to receive Doctor Car dispatch and earlier ASMs administration. Neurological sequelae were associated with prolonged seizure duration and delayed seizure cessation after ASMs administration, but not with time to ASMs administration. Neurological sequelae did not differ significantly between the groups.
CONCLUSIONS: Doctor Car dispatch was associated with earlier prehospital ASMs administration, shorter seizure duration, and increased likelihood of seizure cessation within the ILAE t2 threshold in pediatric SE. These findings support the role of physician-staffed ambulances in improving prehospital seizure management and may contribute to reducing neurological injury.
METHODS: We conducted a medical record-based retrospective study of children aged ≤15 years with SE transported to a tertiary emergency center between December 2014 and November 2024. The primary endpoint was neurological sequelae at hospital discharge. Secondary endpoints included time to antiseizure medications (ASMs) administration, seizure duration, seizure cessation within the International League Against Epilepsy (ILAE) t2 threshold, and mechanical ventilation. Propensity score matching, subgroup analysis according to the t2 threshold, and Bonferroni correction were performed.
RESULTS: Twenty-one patients in the Doctor Car group and 127 in the non-Doctor Car group were analyzed, with 17 matched pairs. Doctor Car dispatch was associated with shorter time to ASMs administration and shorter seizure duration before and after propensity score matching. Patients whose seizures ceased within the ILAE t2 threshold were more likely to receive Doctor Car dispatch and earlier ASMs administration. Neurological sequelae were associated with prolonged seizure duration and delayed seizure cessation after ASMs administration, but not with time to ASMs administration. Neurological sequelae did not differ significantly between the groups.
CONCLUSIONS: Doctor Car dispatch was associated with earlier prehospital ASMs administration, shorter seizure duration, and increased likelihood of seizure cessation within the ILAE t2 threshold in pediatric SE. These findings support the role of physician-staffed ambulances in improving prehospital seizure management and may contribute to reducing neurological injury.