# Active Seizures on Arrival at the Hospital During Ambulance Transfers in Children: A Five-Year Record Review

## TL;DR

This study finds that a significant number of children still have active seizures when arriving at the hospital after ambulance transport, highlighting the need for immediate treatment at the scene.

## Contribution

The study provides new data on seizure continuation during ambulance transfers in Japan, where prehospital antiseizure treatment is prohibited.

## Key findings

- 15% of ambulance transfers involved children with active seizures upon hospital arrival.
- 66% of children with active seizures at the emergency site continued to seize until hospital arrival.
- The incidence of first-time status epilepticus was 118 per 100,000 children aged six or under.

## Abstract

Introduction

Seizure disorders are common in childhood, and some patients develop prolonged seizures or status epilepticus (SE). It remains unknown what proportion of children experience continuous seizures upon hospital arrival after ambulance transfer. In Japan, prehospital treatment using antiseizure medications by the emergency medical service (EMS) is prohibited. Clarifying the natural course of seizures during ambulance transfer may help develop policies to prevent prolonged seizures in children.

Methods

We reviewed the EMS records of the Izumo Fire Department, Shimane, Japan, from January 1, 2018, to December 31, 2022, for all cases of seizures in children aged six years or under, focusing on seizure continuation during ambulance transfer. The Izumo Fire Department covers areas around Izumo City, with a total population of approximately 175,000.

Results

Out of 1,164 emergency transfers, 667 were seizure-related (494 children), with febrile seizures comprising 558 cases (84%). Active seizures were noted at the emergency call site in 19% (n = 126) of transfers upon ambulance arrival. Of these, 66% continued to seize until hospital arrival. Upon arrival at the hospital, seizures persisted in 97 transfers (15%), including 83 continuous and 14 recurrent seizure episodes. The study recorded 93 episodes of SE (14%). The mean incidence of first-time SE based on ambulance transfers was 118 per 100,000 children aged six years or under, ranging from 88 to 142.

Conclusions

A substantial number of children transferred by ambulance had active seizures upon hospital arrival. Immediate treatment is warranted at the emergency call site upon ambulance arrival.