Retrospective comparative analysis.
SETTING: Tertiary academic medical center with two emergency departments and two neurologic intensive care units.
PATIENTS: None.
MEASUREMENTS AND MAIN RESULTS: Of 126 patients with 144 separate
status epilepticus admissions, 57 were female (45%) with mean age 54.7 ± 15.7 yrs.
Status epilepticus was convulsive in 132 cases (92%).
Status epilepticus etiologies included subtherapeutic
antiepileptic drugs (43%), alcohol or other nonantiepileptic
drug (13%), and acute
central nervous system disease (12%). Third-line
antiepileptic drugs were administered in 47 cases (33%). Seventy-eight
status epilepticus episodes (54%) had good outcomes (Glasgow Outcome Score = 1, 2) at the time of hospital discharge. On univariate analysis, poor outcome (Glasgow Outcome Score > 2) was associated with older age (mean 59.8 ± 15.5 vs. 50.5 ± 13.8 yrs, p < .001), acute
central nervous system disease (21% vs. 4%, p = .001),
mechanical ventilation (76% vs. 53%, p = .004), longer duration of ventilation (median 10 days [range 1-56] vs. 2 days [range 1-10], p < .001), treatment with vasopressors (35% vs. 5%, p < .001), and treatment with third-line
antiepileptic drugs (51% vs. 17%, p < .001). Death was associated with acute
central nervous system disease, prolonged ventilation, treatment with vasopressors, and treatment with third-line
antiepileptic drugs. Predictors of poor outcome among all
status epilepticus episodes were older age (odds ratio 1.06; 95% confidence interval 1.03-1.09; p < .001), treatment with third-line
antiepileptic therapy (odds ratio 5.64; 95% confidence interval 2.31-13.75; p < .001), and first episode of
status epilepticus (odds ratio 3.73; 95% confidence interval 1.38-10.10; p = .010). Among
status epilepticus episodes treated by third-line
antiepileptic drugs, predictors of poor outcome were older age (odds ratio, 1.09; 95% confidence interval 1.01-1.18; p = .038) and longer ventilation (odds ratio, 1.47; 95% confidence interval 1.08-2.00; p = .015). Predictors of mortality among all
status epilepticus episodes were treatment with third-line
antiepileptic drugs (odds ratio, 12.08; 95% confidence interval 2.30-63.39; p = .003) and older age (odds ratio, 1.06; 95% confidence interval 1.00-1.12; p = .045).
CONCLUSIONS: