Journal Club: Seize the Day!

ESETT Trial

Kapur, Jaideep, et al. “Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus.” New England Journal of Medicine, vol. 381, no. 22, 2019, pp. 2103–2113., doi:10.1056/nejmoa1905795. The ESETT trial was a multicenter, comparative effectiveness trial which compared the efficacy and safety of 3 IV anticonvulsive agents: levetiracetam, fosphenytoin, and valproate in benzodiazepine refractory children and adults. It used a response adaptive technique in order to randomize more patients to the most effective treatment. The primary outcome was the absence of clinically evident seizures and improvement in the level of consciousness by 60 minutes after the start of drug infusion. Safety outcomes included life-threatening hypotension or cardiac arrhythmia, endotracheal intubation, seizure recurrence, and death. The results showed that the three anticonvulsant drugs each led to seizure cessation and improved alertness by 60 minutes in approximately half of their patients. It also did not demonstrate a significant difference in adverse effects. Bedside US for Diagnosis of Skull Fractures Choi, Jea Yeon, et al. “Accuracy of Bedside Ultrasound for the Diagnosis of Skull Fractures in Children Aged 0 to 4 Years.” Pediatric Emergency Care, Publish Ahead of Print, 2018, doi:10.1097/pec.0000000000001485. This was a single-center prospective study involving patients with head injuries aged 0-4 years old. The objective of the study was to assess the accuracy of bedside ultrasound performed by emergency physicians for diagnosing skull fractures in children. The results were compared with CT scan interpretations by radiologists. The study showed that US had a sensitivity and specificity of 76.9% and 100%. There were 3 false negatives in the study which involved fractures of the superior orbital wall and occipital scalp which are difficult areas to evaluate. Also, the participating physicians had limited experience with ultrasound. The sensitivity of ultrasound in this study wasn’t sufficient for its use as the sole method of detecting injury however it may be beneficial to add this to our clinical training as emergency physicians. February Journal Club Discussion Leader: Elizabeth Ray-Smith, MD (PGY-2) 2019-2020 Academic Year Journal Club Leaders: Sarah Balog, DO (PGY-3); Rose Solomon, MD (PGY-2); David Andonian, MD (Faculty Advisor)