Antiseizure Medication Administration Gaps Across the ICU-to-Floor Transfer: A Matched Within-Patient Comparison
- 1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Abstract
ObjectiveWhether a scheduled antiseizure medication (ASM) continues on schedule across the ICU-to-floor transfer has not been characterized. We quantified ASM administration-gap frequency across this transfer and compared it with gap frequency during matched non-transfer intervals in the same patient and drug.
MethodsIn this retrospective MIMIC-IV (version 3.1) cohort study, we identified epilepsy and status-epilepticus admissions with an ICU stay followed by floor transfer and a scheduled ASM order active at ICU departure. A gap was defined as an interval exceeding 1.5 times the expected dosing interval between the last ICU dose and first floor dose, or no further dose before discharge, and compared with a matched non-transfer control interval in the same patient and drug (paired McNemar test). A multivariable model evaluated six prespecified clinical predictors; sociodemographic variables were summarized descriptively.
ResultsAmong 2,469 ASM transition-by-drug observations (1,583 admissions, 1,335 patients), an administration gap occurred in 251 (10.2%; 95% CI, 8.7%-11.7%). Gap frequency across the transfer exceeded frequency during matched non-transfer control intervals in the same patient and drug: a paired rate difference of 5.8 percentage points (95% CI, 4.4-7.1; 7.5% vs 1.7%; P = 7.3 x 10-22) before the transfer and 6.4 percentage points (95% CI, 4.9-7.9; 8.9% vs 2.5%; P = 1.9 x 10-23) after. Gap rates were similar for intravenous-available (9.9%) and oral-only (11.4%) drugs (rate difference, 1.5 percentage points; 95% CI, -1.6 to 4.5; P = .34). None of six prespecified predictors reached significance after correction.
SignificanceAn antiseizure medication administration gap occurred in approximately 1 of every 10 drug-transition observations at the ICU-to-floor transfer, exceeding matched non-transfer gap rates by 5.8 to 6.4 percentage points. This transfer-associated excess, rather than any single medication or patient characteristic, supports a structured medication-continuity check.
Key PointsO_LIAntiseizure medication administration gaps occurred in 10.2% of ICU-to-floor drug transitions (95% CI, 8.7%-11.7%). C_LIO_LIGap frequency was 5.8-6.4 percentage points higher across the transfer than during matched non-transfer control intervals. C_LIO_LINo prespecified clinical predictor or IV-availability class identified a clearly higher-risk subgroup. C_LIO_LIGap rates were similar for intravenous-available and oral-only medications (9.9% vs 11.4%; difference, 1.5 points; 95% CI, -1.6 to 4.5). C_LIO_LIA structured medication-continuity check at the ICU-to-floor transfer may reduce this administration gap. C_LI
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BibTeX
@misc{gorenshtein2026antiseizure,
title = {{Antiseizure Medication Administration Gaps Across the ICU-to-Floor Transfer: A Matched Within-Patient Comparison}},
author = {A. Gorenshtein and Y. Adiniaev and A. Srour and E. Klang and O. Daniel},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.26.26361462},
url = {https://www.medrxiv.org/content/10.64898/2026.08.26.26361462v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Antiseizure Medication Administration Gaps Across the ICU-to-Floor Transfer: A Matched Within-Patient Comparison
AU - A. Gorenshtein
AU - Y. Adiniaev
AU - A. Srour
AU - E. Klang
AU - O. Daniel
PY - 2026
DA - 2026/08/26
PB - medRxiv
DO - 10.64898/2026.08.26.26361462
UR - https://www.medrxiv.org/content/10.64898/2026.08.26.26361462v1
AB - ObjectiveWhether a scheduled antiseizure medication (ASM) continues on schedule across the ICU-to-floor transfer has not been characterized. We quantified ASM administration-gap frequency across this transfer and compared it with gap frequency during matched non-transfer intervals in the same patient and drug. MethodsIn this retrospective MIMIC-IV (version 3.1) cohort study, we identified epilepsy and status-epilepticus admissions with an ICU stay followed by floor transfer and a scheduled ASM order active at ICU departure. A gap was defined as an interval exceeding 1.5 times the expected dosing interval between the last ICU dose and first floor dose, or no further dose before discharge, and compared with a matched non-transfer control interval in the same patient and drug (paired McNemar test). A multivariable model evaluated six prespecified clinical predictors; sociodemographic variables were summarized descriptively. ResultsAmong 2,469 ASM transition-by-drug observations (1,583 admissions, 1,335 patients), an administration gap occurred in 251 (10.2%; 95% CI, 8.7%-11.7%). Gap frequency across the transfer exceeded frequency during matched non-transfer control intervals in the same patient and drug: a paired rate difference of 5.8 percentage points (95% CI, 4.4-7.1; 7.5% vs 1.7%; P = 7.3 x 10-22) before the transfer and 6.4 percentage points (95% CI, 4.9-7.9; 8.9% vs 2.5%; P = 1.9 x 10-23) after. Gap rates were similar for intravenous-available (9.9%) and oral-only (11.4%) drugs (rate difference, 1.5 percentage points; 95% CI, -1.6 to 4.5; P = .34). None of six prespecified predictors reached significance after correction. SignificanceAn antiseizure medication administration gap occurred in approximately 1 of every 10 drug-transition observations at the ICU-to-floor transfer, exceeding matched non-transfer gap rates by 5.8 to 6.4 percentage points. This transfer-associated excess, rather than any single medication or patient characteristic, supports a structured medication-continuity check. Key PointsO_LIAntiseizure medication administration gaps occurred in 10.2% of ICU-to-floor drug transitions (95% CI, 8.7%-11.7%). C_LIO_LIGap frequency was 5.8-6.4 percentage points higher across the transfer than during matched non-transfer control intervals. C_LIO_LINo prespecified clinical predictor or IV-availability class identified a clearly higher-risk subgroup. C_LIO_LIGap rates were similar for intravenous-available and oral-only medications (9.9% vs 11.4%; difference, 1.5 points; 95% CI, -1.6 to 4.5). C_LIO_LIA structured medication-continuity check at the ICU-to-floor transfer may reduce this administration gap. C_LI
ER -