Intranasal (IN) midazolam is a fast and painless way to treat pediatric prehospital seizures and could be a preferrable method compared to intravenous (IV) or intramuscular (IM) administration if outcomes do not differ. A study published in Prehospital Emergency Care compared the effectiveness of IN-administered midazolam versus midazolam administered by other routes in the treatment of pediatric prehospital seizures.
A retrospective, non-inferiority analysis was conducted with data from a regional Emergency Medical Services (EMS) database that housed data on pediatric patents (aged ≤14 years) who received midazolam 0.1 mg/kg from EMS for non-traumatic seizures. The main outcome was the proportion of patients who needed midazolam redosing after initial IN midazolam treatment versus those who received IV or IM midazolam. A prior risk difference of 6.5% was used as the non-inferiority margin.
Final analysis included 2,034 patients. The median age was six years (interquartile range, 3-10 years), and 55% of patients were male. Most of the initial administration routes were IV (n=1,024 [50%]), followed by IM (n=547 [27%]), IN (n=461 [23%]), and intraosseous (n=2 [0.1%]). In the group initially treated with IN midazolam, 116 patients (25%) required redosing, compared to 222 patients (14%) who initially received midazolam via alternate routes, for a risk difference of 11% (95% confidence interval [CI], 7-15%). When adjusting for age, the odds ratio for redosing following IN administration, compared to other routes of administration, was 2 (95% CI, 1.6-2.6).
“Prehospital treatment of pediatric seizure with intranasal midazolam was associated with increased frequency of redosing compared to midazolam administered by other routes, suggesting that 0.1 mg/kg is a subtherapeutic dose for intranasal midazolam administration,” the researchers wrote in their conclusion.