A retrospective cross-sectional study of the prevalence of generalized convulsive status epilepticus in traumatic brain injury: United States 2002–2010

Abstract

PurposeTo determine the incidence, predictors, and outcomes of generalized convulsive status epilepticus (GCSE) in traumatic brain injury (TBI) patients. MethodsWe conducted a retrospective cross-sectional study of adult patients with acute TBI using the 2002–2010 Nationwide Inpatient Sample (NIS) database of USA. We used multivariable logistic regression analyses to identify independent predictors of GCSE in patients with TBI and to determine the impact of GCSE on outcomes (in-hospital mortality, length of stay, total hospital charges, and discharge disposition). ResultsAmong 1,457,869 patients hospitalized with TBI, 2315 (0.16%) had GCSE. In-hospital mortality was significantly higher in patients with GCSE (32.5% vs. 9.6%; unadjusted OR 4.54, 95% CI 4.16–4.96; p<0.001; adjusted OR 3.41; 95% CI 3.09–3.76p<0.001). Patients with GCSE had longer length of stay (17.3±21.9 vs. 6.8±11.1 days; p<0.001), higher total hospital charges ($147,415±162,319 vs. $54,041±90,524; p<0.001), and were less likely to be discharged home (19.8% vs. 52.7%; p<0.001). Using multivariable logistic regression analysis, age >35 years (OR 2.15; 95% CI 1.87–2.47), CNS infections (OR 4.86; 95% CI 3.70–6.38), anoxic brain injury (OR 9.54; 95% CI 8.10–11.22), and acute ischemic stroke (OR 4.09; 95% CI 3.41–4.87) were independent predictors of GCSE in TBI patients. Epilepsy was an independent negative predictor of GCSE (OR 0.74; 95% CI 0.55–0.99). ConclusionDespite its low incidence, GCSE in TBI patients was associated with worse outcomes with threefold higher in-hospital mortality, prolonged hospitalization, higher hospital charges, and worse discharge disposition. Surprisingly, epilepsy is a negative predictor of GCSE in this population.