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SeizuresPhase 3PediDOSENCT05121324

Pediatric Dose Optimization for Seizures in Emergency Medical Services

A Phase 3 study testing Standardized seizure protocol and Conventional seizure protocol in people with Seizures, run by Stanford University at 20 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The Pediatric Dose Optimization for Seizures in Emergency Medical Services (PediDOSE) study is designed to improve how paramedics treat seizures in children on ambulances. Seizures are one of the most common reasons why people call an ambulance for a child, and paramedics typically administer midazolam to stop the… Read more about this study

Who is it for?
Ages 6 months to 13 years
Conditions the study is for
Seizures
What is being tested?
Standardized seizure protocol and Conventional seizure protocol
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
6,700 participants
Where
20 sitesUnited States
Study dates
8 Aug 2022to 30 Sep 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 months to 13 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Witnessed by the paramedic to be actively seizing, regardless of seizure type or duration; AND
  • Under the care of a paramedic; AND
  • Transported by an EMS agency participating in the study

Who cannot join

  • A prior history of a benzodiazepine allergy; OR
  • Known or presumed pregnancy; OR
  • Severe growth restriction based on the paramedic's subjective assessment

Trial locations and contacts

20 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Manish I Shah, MD, MS contact

650-723-3319

mshah5@stanford.edu

Leonard Basobas, MS contact

773-504-5963

lbasobas@stanford.edu

20 sites in 1 country

United States20 sites, 20 recruiting
  • University of Michigan

    Ann Arbor, Michigan, 48105

    Stacey Noel, MD, 734-763-7488, sknoel@med.umich.edu

    Recruiting
  • Emory University

    Atlanta, Georgia, 30322

    Claudia R Morris, MD, 404-727-5500, claudia.r.morris@emory.edu

    Recruiting
  • University of Colorado

    Aurora, Colorado, 80045

    Kathleen Adelgais, MD, MPH, 303-724-2595, kathleen.adelgais@childrenscolorado.org

    Recruiting
  • University at Buffalo

    Buffalo, New York, 14203

    Brian Clemency, MD, 716-645-9726, bc34@buffalo.edu

    Recruiting
  • Mecklenburg EMS

    Charlotte, North Carolina, 28226

    Douglas Swanson, MD, 704-355-2000, dswanson@medic911.com

    Recruiting
  • Cincinnati Children's Hospital Medical Center

    Cincinnati, Ohio, 45229

    Lauren Riney, DO, 513-803-2969, lauren.riney@cchmc.org

    Recruiting
  • Nationwide Children's Hospital

    Columbus, Ohio, 43205

    Julie Leonard, MD, MPH, 614-722-4384, julie.leonard@nationwidechildrens.org

    Recruiting
  • University of Texas Southwestern

    Dallas, Texas, 75235

    Geoffrey Lowe, MD, 214-456-1359, geoffrey.lowe@utsouthwestern.edu

    Recruiting
  • Baylor College of Medicine

    Houston, Texas, 77030

    Kathryn M Kothari, MD, 832-824-5497, kathryn.kothari@bcm.edu

    Recruiting
  • Indiana University

    Indianapolis, Indiana, 46202

    Gregory W Faris, MD, 317-962-3886, gfaris@iu.edu

    Recruiting
  • Children's Hospital of Los Angeles

    Los Angeles, California, 90027

    Todd P Chang, MD, MAcM, 323-361-2109, tochang@chla.usc.edu

    Recruiting
  • Medical College of Wisconsin

    Milwaukee, Wisconsin, 53226

    Lorin Browne, DO, 414-266-2625, lbrowne@mcw.edu

    Recruiting
  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15224

    Sylvia Owusu-Ansah, MD, MPH, 412-692-7692, sylvia.owusuansah@chp.edu

    Recruiting
  • Oregon Health and Sciences University

    Portland, Oregon, 97239

    Matthew Hansen, MD, MCR, 503-494-7551, hansemat@ohsu.edu

    Recruiting
  • University of California, Davis

    Sacramento, California, 95817

    Daniel Nishijima, MD, MAS, 916-734-3884, dnishijima@ucdavis.edu

    Recruiting
  • University of Utah

    Salt Lake City, Utah, 84108

    Maija Holsti, MD, MPH, 801-587-7450, maija.holsti@hsc.utah.edu

    Recruiting
  • University of California, San Francisco

    San Francisco, California, 94143

    Nicolaus Glomb, MD, MPH, 415-476-3345, nicolaus.glomb@ucsf.edu

    Recruiting
  • University of Washington

    Seattle, Washington, 98104

    Andrew Latimer, MD, 206-521-1588, alatim@uw.edu

    Recruiting
  • University of Arizona

    Tucson, Arizona, 85724

    Joshua B Gaither, MD, 520-626-1670, jgaither@aemrc.arizona.edu

    Recruiting
  • Children's National Hospital

    Washington D.C., District of Columbia, 20010

    Kathleen Brown, MD, 202-476-4177, kbrown@childrensnational.org

    Recruiting

Other trials in United States

About this study

Official title: Pediatric Dose Optimization for Seizures in EMS (PediDOSE)

The Pediatric Dose Optimization for Seizures in Emergency Medical Services (PediDOSE) study is designed to improve how paramedics treat seizures in children on ambulances. Seizures are one of the most common reasons why people call an ambulance for a child, and paramedics typically administer midazolam to stop the seizure. One-third of children with active seizures on ambulances arrive at emergency departments still seizing. Prior research suggests that seizures on ambulances continue due to under-dosing and delayed delivery of medication. Under-dosing happens when calculation errors occur, and delayed medication delivery occurs due to the time required for dose calculation and placement of an intravenous line to give the medication. Seizures stop quickly when standardized medication doses are given as a muscular injection or a nasal spray. This research has primarily been done in adults, and evidence is needed to determine if this is effective and safe in children.

PediDOSE optimizes how paramedics choose the midazolam dose by eliminating calculations and making the dose age-based. This study involves changing the seizure treatment protocols for ambulance services in 20 different cities, in a staggered and randomly-assigned manner.

Read more

One aim of PediDOSE is to determine if using age to select one of four standardized doses of midazolam and giving it as a muscular injection or nasal spray is more effective than the current calculation-based method, as measured by the number of children arriving at emergency departments still seizing. The investigators believe that a standardized seizure protocol with age-based doses is more effective than current practice.

Another aim of PediDOSE is to determine if a standardized seizure protocol with age-based doses is just as safe as current practice, since either ongoing seizures or receiving too much midazolam can interfere with breathing. The investigators believe that a standardized seizure protocol with age-based doses is just as safe as current practice, since the seizures may stop faster and these doses are safely used in children in other healthcare settings.

If this study demonstrates that standardized, age-based midazolam dosing is equally safe and more effective in comparison to current practice, the potential impact of this study is a shift in the treatment of pediatric seizures that can be easily implemented in ambulance services across the United States and in other parts of the world.

Conditions
Seizures
Being tested
Standardized seizure protocol, Conventional seizure protocol
Keywords
Child, Emergency Medical Services
Medical subject headings
Seizures

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Standardized seizure protocolDrug

    Also called midazolam

    The intervention is a standardized seizure protocol for paramedics that prioritizes administration of only intramuscular (IM) or intranasal (IN) midazolam, up to 2 doses given 5 minutes apart, with age-based dosing as follows: 6-16 months (1.25 mg); 17 months-5 years (2.5 mg); 6-11 years (5 mg); 12-13 years (10 mg).

  • Conventional seizure protocolDrug

    Also called midazolam

    The control is the EMS agency's current seizure protocol, based on conventional calculation-based dosing. These vary from one EMS agency to the other with respect to recommended midazolam doses ranging from 0.05-0.3 mg/kg and with multiple route choices listed, including intravenous, intraosseous, intramuscular, intranasal, and rectal.

    for paramedics that prioritizes administration of only intramuscular (IM) or intranasal (IN) midazolam, up to 2 doses given 5 minutes apart, with age-based dosing as follows: 6-16 months (1.25 mg); 17 months-5 years (2.5 mg); 6-11 years (5 mg); 12-13 years (10 mg).

Study groups in NCT05121324
Study groupRoleWhat they receive
InterventionExperimentalThis arm will be exposed to the study intervention: a standardized seizure protocol.
Receives: Drug: Standardized seizure protocol
ControlActive comparatorThis arm will be exposed to the emergency medical services (EMS) agency's existing seizure protocol; this is the control arm
Receives: Drug: Conventional seizure protocol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Seizing on emergency department arrival

    Binary assessment of whether the participant is seizing or not upon arrival to the emergency department, as measured by either a rapid response electroencephalogram (preferred) or clinical judgement (alternative).

    Measured: Between arrival to the emergency department and 10 minutes after arrival

Secondary outcomes (2)
  1. Respiratory failure

    A binary assessment of insufficient breathing at any point during EMS care or within 30 minutes of emergency department arrival, defined as having received bag valve mask ventilation, bi-level positive airway pressure, placement of a supraglottic airway or endotracheal intubation.

    Measured: Between paramedic arrival on scene until 30 minutes after emergency department arrival

  2. Time to first midazolam administration

    Time in minutes from paramedic arrival to the scene until the paramedic administers midazolam to the patient

    Measured: From paramedic arrival to the scene until emergency department arrival, assessed up to 1 hour after paramedic scene arrival or 1 minute after emergency department arrival, whichever occurs last

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Nov 2021
  2. Study start8 Aug 2022
  3. Primary completion31 Jul 2026 (estimated)
  4. Study completion30 Sep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a stepped-wedge, cluster-randomized trial. Every 2 months, 1 of the 20 sites will transition, in a staggered manner, from the control (conventional protocol with calculation-based dosing) to the intervention (standardized protocol with age-based dosing), such that all 20 sites will ultimately implement the intervention during the 4-year enrollment period.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
6,700 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05121324
Sponsor's protocol ID
73018
Other IDs
U01NS114042, BCM H-49824
Acronym
PediDOSE
Status last verified
Sep 2025
First submitted
26 Oct 2021
Last updated
30 Sep 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: After subject enrollment and follow up have been completed, the Data Coordinating Center (DCC) for the study will prepare a final study database for analysis. A releasable database will be produced and completely de-identified in accordance with the definitions provided in the Health Insurance Portability and Accountability Act (HIPAA). Namely, all identifiers specified in HIPAA will be recoded in a manner that will make it impossible to deduce or impute the specific identity of any participant. The database will not contain institutional identifiers. The DCC will also prepare a data dictionary that provides a concise definition of every data element included in the database. If specific data elements have idiosyncrasies that might affect interpretation or analysis, this will be discussed in the dictionary document. In accordance with policies determined by the investigators and funding sponsors, the releasable database will be provided to users in electronic form.

Publications

  • Shah MI, Ostermayer DG, Browne LR, Studnek JR, Carey JM, Stanford C, Fumo N, Lerner EB. Multicenter Evaluation of Prehospital Seizure Management in Children. Prehosp Emerg Care. 2021 Jul-Aug;25(4):475-486. doi: 10.1080/10903127.2020.1788194. Epub 2020 Jul 17.

    PubMed 32589502
  • Carey JM, Studnek JR, Browne LR, Ostermayer DG, Grawey T, Schroter S, Lerner EB, Shah MI. Paramedic-Identified Enablers of and Barriers to Pediatric Seizure Management: A Multicenter, Qualitative Study. Prehosp Emerg Care. 2019 Nov-Dec;23(6):870-881. doi: 10.1080/10903127.2019.1595234. Epub 2019 May 13.

    PubMed 30917730
  • Shah MI, Macias CG, Dayan PS, Weik TS, Brown KM, Fuchs SM, Fallat ME, Wright JL, Lang ES. An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology. Prehosp Emerg Care. 2014;18 Suppl 1:15-24. doi: 10.3109/10903127.2013.844874. Epub 2013 Dec 3.

    PubMed 24298939
  • Johnson AR, Riches NO, VanBuren JM, Corona AE, Jacobsen K, Yang S, Shah MI; Pediatric Emergency Care Applied Research Network (PECARN) PediDOSE Study Investigators. Measuring the efficacy of community consultation in a pediatric exception from informed consent trial. Acad Emerg Med. 2025 May;32(5):506-515. doi: 10.1111/acem.15073. Epub 2024 Dec 29.

    PubMed 40365924
  • Kornblith AE, Singh C, Innes JC, Chang TP, Adelgais KM, Holsti M, Kim J, McClain B, Nishijima DK, Rodgers S, Shah MI, Simon HK, VanBuren JM, Ward CE, Counts CR. Analyzing patient perspectives with large language models: a cross-sectional study of sentiment and thematic classification on exception from informed consent. Sci Rep. 2025 Feb 20;15(1):6179. doi: 10.1038/s41598-025-89996-w.

    PubMed 39979559
  • Ward CE, Adelgais KM, Holsti M, Jacobsen KK, Simon HK, Morris CR, Gonzalez VM, Lerner G, Ghaffari K, VanBuren JM, Lerner EB, Shah MI; Pediatric Emergency Care Applied Research Network (PECARN) PediDOSE Study Group. Public support for and concerns regarding pediatric dose optimization for seizures in emergency medical services: An exception from informed consent (EFIC) trial. Acad Emerg Med. 2024 Jul;31(7):656-666. doi: 10.1111/acem.14884. Epub 2024 Mar 7.

    PubMed 38450918

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Standardized seizure protocol and Conventional seizure protocol in people with Seizures, run by Stanford University at 20 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 30 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 20 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Manish I Shah, MD, MS (650-723-3319, mshah5@stanford.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Seizing on emergency department arrival (time frame: Between arrival to the emergency department and 10 minutes after arrival). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05121324, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Sep 2025.

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