Treatment of Seizures in Children and Adults in the Emergency Medical System of the City of Zurich, Switzerland – Midazolam vs. Diazepam – A Retrospective Analysis

Abstract Introduction Seizures count to critical situations emergency medical systems (EMS) are confronted with. Objectives Evaluation of a modified treatment algorithm (MTAS-EMS) using diazepam and midazolam due to a supply bottleneck of iv lorazepam in 2012. Methods Retrospective study where data from patients treated for seizures by the EMS of the city of Zurich were analyzed. Effectiveness of the MTAS-EMS and i.v. diazepam in children and adults was compared with respect of cessation of seizure without recurrence over the period until arrival at the hospital. The chi-square and Fisher's exact test were used to compare categorical data. The Student’s t -test and Mann Whitney test were used to compare numerical data. p -values Results Of 584 documented missions, 165 treated patients (126 adults and 39 children) were included. 115 patients (80 adults and 35 children) were treated according the MTAS-EMS. Cessation of seizure was achieved in 85% of the adults and in 97% of the children, if all options of the MTAS-EMS were used. The first dose of nasal midazolam was more successful in children compared to adults ( p = 0.012). In adults, the single dose of i.v. diazepam terminated the seizure in 98% ( p = 0.001) compared to 57% for the single dose of iv and 64% for nasal midazolam. Conclusions The treatment success of the MTAS-EMS is high. However, in adults the single dose of i.v. diazepam is as successful as the completely used MTAS-EMS and seems to be superior to the single dose iv and nasal midazolam.