PediDOSE: Faster Help for Children with Seizures

First published March 2022
Updated May 2026

Seizures are one of the most common reasons why people call 9-1-1 for children. Seizures that do not stop on their own could lead to death or serious injury. Paramedics are Emergency Medical Services (EMS) clinicians who are trained to treat children who are having seizures with a medicine called midazolam. Midazolam is a proven treatment paramedics already use to stop a seizure quickly.

But delays in giving midazolam happen when paramedics must do math to know the dose. Due to this, nearly half of children are given the wrong dose, usually an underdose. Another option paramedics have is to start an IV, which lengthens the time to get a dose of midazolam. Delayed and underdosed seizure medicine can cause 1 in 3 children to arrive at the emergency department still having a seizure.

The Pediatric Dose Optimization for Seizures in EMS (PediDOSE) trial aims to understand the way paramedics choose how much medicine to give to see if researchers can make it easier and faster for them to give medicine and stop seizures. Principal Investigator, Manish I. Shah, MD, MS created PediDOSE, which aims to lessen the number of children arriving at the emergency department with an ongoing seizure while making sure children are safe.

Paramedics taking part in this study have changed the way they choose how much medicine to give children ages 6 months to 13 years having seizures. Over the last 4 years, Nationwide Children's Hospital researchers have collected information about seizures and medicines given by paramedics in eligible children. Nationwide Children’s Hospital is the 4th highest enrolling site for PediDOSE, after children’s hospitals in Los Angeles, Houston, and Dallas. 98% of children eligible for PediDOSE at Nationwide Children’s Hospital enrolled in the study.

Eligible children will continue to be enrolled under an exception from informed consent (EFIC) process that follows rules for research. This has been approved by a research ethics review board. Parents or guardians of those children enrolled in this study will be notified about the study after enrollment. EFIC studies require representation of the community in surveys and conversations. A recent study led by Ann R Johnson, MD about community involvement in PediDOSE EFIC consultation showed that there were demographic differences among the children enrolled in the study and those who joined community consultation efforts. Overall thoughts about the study, however, were similar between parents of children enrolled and community consultation participants.¹ Although community consultations for PediDOSE have finished, similar studies will continue to happen and need broader community consultation.

PediDOSE will complete enrollment in Summer 2026. Results from the study will be shared after review.

For more information on this study, listen to PediaCast episode 509, Emergency Seizure Care, PediDOSE and Exception from Informed Consent.