Clinico-Etiological Profile and Outcome of Children with Status Epilepticus Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital - A Prospective Observational Study

Abstract

Objectives: We undertook this study to describe the clinical-etiological profile of children less than 12 years age with Status Epilepticus (SE) and to study the risk factors and etiologies associated with refractory status epilepticus (RSE), outcome at end of hospital stay and predictors of favourable/unfavourable outcome in SE. Materials and Methods: Study design-Hospital based Prospective observational study. Setting-Pediatric Intensive Care Unit of a tertiary care referral hospital in Kerala, India for a period of 1 year from April 2017 to April 2018. 111 children, less than 12 years age, admitted consecutively with SE were enrolled in the study. The information regarding the parameters in a structured proforma were collected by the primary investigator and entered after careful examination and appropriate investigations. Final outcome at the end of hospital stay was noted. The data collected were analyzed to identify significant factors which may predict the outcome and the risk factors associated with RSE. Statistical Analysis: Data collected were entered in Microsoft Excel Sheet-2013.Analysis was done using Statistical Package for Social Sciences software(IBM SPSSv24).Quantitative variables were summarised as mean and SD and categorical variables as proportions. For testing significance of association, Chi square test was done for categorical variables and Independent T-test was done for continuous variables. P value<0.05 was considered significant. The odds ratio with 95% confidence interval of each of the dichotomous variables by univariate analysis were determined. Results: SE was found to be more common in 1-6 years age group followed by infancy. 51.4% of cases were boys and 48.6% were girls. Most common cause of status was febrile status followed by meningoencephalitis. Anemia was significantly associated with RSE (p-value=0.001) and was found to be a risk factor (odds ratio=8.68). 9 (8.1%) children expired. Unfavourable outcome was observed more in children who remained pain responsive or unresponsive 6 hours after seizure control, which was significant (p value<0.01). Delay in initiation of first anti-epileptic drug (AED) was significantly associated with progression to RSE and unfavourable outcome. Conclusion: We found that anemia and delay in initiation of first AED was significantly associated with RSE. There was also significant association between unfavourable outcome and children who remained pain-responsive or unresponsive 6 hours after seizure control. Keywords: anemia, antiepileptic, febrile status, meningitis, mortality.