From international guidelines to real-world practice consensus on investigations and management of status epilepticus in adults: A modified Delphi approach

• Main Authors: Chusak Limotai, Kanokwan Boonyapisit, Piradee Suwanpakdee, Suda Jirasakuldej, Kwuanrat Wangponpattanasiri, Sattawut Wongwiangiunt, Tipakorn Tumnark, Panutchaya Noivong, Sirincha Pitipanyakul, Chaiwiwat Tungkasereerak, Phopsuk Tansuhaj, Watchara Rattanachaisit, Polchai Pleumpanupatand, Songchai Kittipanprayoon, Phattarawin Ekkachon, Atiporn Ingsathit, Ammarin Thakkinstian
• Other Authors: Chulalongkorn University
• Format: Article
• Published: 2020
• Subjects: Medicine; Neuroscience
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/53776
• Institution: Mahidol University

© 2020 Elsevier Ltd Objective: To establish a consensus which is practical and ready-to-use on investigations (ISE) and for management of status epilepticus (MSE) in adults using a modified Delphi approach. Patients and methods: A 4-round modified Delphi approach was used. First and second rounds were conducted using Google® survey with structured statements and 6-point Likert scale response. Threshold agreement was set to ≥80%. Third round was a face-to-face meeting aimed to facilitate the development of approach algorithms for ISE and MSE. Fourth round was a final review asking participants to rate the algorithms post completion. Results: The panel consisted of 8 board-certified epileptologists along with 6 neurologists from main regional hospitals across Thailand. Thirty-seven statements for ISE and 68 statements for MSE were used for the Round I survey, 17/37 (45.9%) and 49/68 (72.1%) reached threshold agreement (≥80%). The average absolute-agreement intraclass correlation coefficients for ISE and MSE were 0.82 (95% CI 0.71, 0.89) and 0.81 (95% CI 0.73, 0.87), respectively; indicating good extent of consensus among participants. Upon Round II, further 10/18 (55.6%) for ISE and 10/19 (52.6%) for MSE reached agreement. In Round III, face-to-face point-by-point discussion was performed to generate approach algorithms. All (100%) provided positive responses with the algorithms post completion in Round IV. Conclusion: A practical and ready-to-use consensus using modified Delphi approach on ISE and MSE was developed in a Thai regional hospital context. In real practice, this approach is more suitable and feasible for a localized setting when compared with totally adopting international guidelines.