Abstract
Introduction: Intracerebral hemorrhage (ICH) accounts for 15% of strokes, and an early sequelae of hemorrhagic stroke is seizure. Studies have shown up to 43% of ICH patients experience electrographic seizure within 72 hours of ictus. The clinical course of patients with seizures in ICH remains unclear. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of seizures on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. Results: 2,000,868 patients with ICH were identified; 234,382 had seizures (11.7%). Patients with seizure had higher Elixhauser Comorbidity Score (15.12 ± 8.54 vs. 9.80 ± 8.98, p<0.001) and NIH Stroke Score (13.02 ± 9.85 vs. 11.17 ± 9.46, p<0.001). There were higher rates of coma, fluid/electrolyte dysfunction, CNS infections, craniotomy, and external ventricular drain placement (p<0.01). After propensity matching, patients with seizure were less likely to experience in-hospital mortality (AOR 0.85; 95% CI: 0.82-0.87), more likely to be discharged home or short-term hospital (AOR 1.31; 95% CI: 1.27-1.35), have shorter hospital stay (-0.63 days; 95% CI: -0.82 - -0.45), and lower hospital charges ($-3991.74; 95% CI: $-6196.22- -1787.27) (all p<0.001). Conclusions: The rate of seizure among ICH patients remains unchanged over the past 2 decades. Seizure is associated with more severe presentation; however, it does not independently worsen the clinical outcome.
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