Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus

Tobias Loddenkemper,Amer Alshekhlee,Tanvir U Syed,Sriram Ramgopal,Sikawat Thanaviratananich,Mohamad Z Koubeissi,Deepak Gulati,Sanjeev V Kothare,Joshua L Bonkowsky

doi:10.1371/journal.pone.0047474

Abstract

ObjectiveTo evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE) in a large, multi-center, pediatric cohort.Patients and MethodsWe identified our cohort from the KID Inpatient Database for the years 1997, 2000, 2003 and 2006. We queried the database for convulsive SE, associated diagnoses, and for inpatient death. Univariate logistic testing was used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariable logistic regression procedure. P-values less than 0.05 were taken as significant.ResultsWe identified 12,365 (5,541 female) patients with convulsive SE aged 0–20 years (mean age 6.2 years, standard deviation 5.5 years, median 5 years) among 14,965,571 pediatric inpatients (0.08%). Of these, 117 died while in the hospital (0.9%). The most frequent additional admission ICD-9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure.Independent risk factors for death in patients with SE, assessed by multivariate calculation, included near drowning (Odds ratio [OR] 43.2; Confidence Interval [CI] 4.4–426.8), hemorrhagic shock (OR 17.83; CI 6.5–49.1), sepsis (OR 10.14; CI 4.0–25.6), massive aspiration (OR 9.1; CI 1.8–47), mechanical ventilation >96 hours (OR9; 5.6–14.6), transfusion (OR 8.25; CI 4.3–15.8), structural brain lesion (OR7.0; CI 3.1–16), hypoglycemia (OR5.8; CI 1.75–19.2), sepsis with liver failure (OR 14.4; CI 5–41.9), and admission in December (OR3.4; CI 1.6–4.1). African American ethnicity (OR 0.4; CI 0.2–0.8) was associated with a decreased risk of death in SE.ConclusionPediatric convulsive SE occurs in up to 0.08% of pediatric inpatient admissions with a mortality of up to 1%. There appear to be several risk factors that can predict mortality. These may warrant additional monitoring and aggressive management.

Highlights

Status epilepticus (SE) is characterized by prolonged seizures or by multiple seizures without full restoration of consciousness between events [1]
We investigate potential risk factors leading to death in children presenting with generalized convulsive SE
One-hundred-and-seventeen patients (0.95%) with convulsive SE died during their inpatient admission

Summary

Introduction

Status epilepticus (SE) is characterized by prolonged seizures or by multiple seizures without full restoration of consciousness between events [1]. The condition is associated with significant morbidity and mortality. SE is thought to have a fatality rate of approximately 2% [2,3]. Complications of SE are significant and include refractory epilepsy, neurologic deficits and repeated episodes of SE [4]. While a number of studies have identified associations for poor outcomes in SE [5,6], the use of publically available hospital databases with large sample sizes may allow for better determination of morbidity and mortality risk factors for patients with this condition. We investigate potential risk factors leading to death in children presenting with generalized convulsive SE

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Discussion

Conclusion