Determinants of outcome in convulsive status epilepticus in adults: An ambispective study from central India

Abstract

Background:The determinants of the outcome in adult convulsive status epilepticus(CSE), also the implication of the value of mean arterial blood pressure (MAP), and random blood sugar at admission on the outcome are not clear.Objectives:The objective of this study is to look for the determinants of unfavorable outcome in CSE.Materials and Methods:Ambispectively gathered data from 55 patients, treated consecutively with identical protocol during January 2010–December 2016, were analyzed. The demographic and clinical variables were identified and correlated with outcome in each individual.Results:There were 65.45% males and 34.55% females. Favorable outcome (conscious and discharged) was seen in 63.6%, unfavorable (death 14.5%, absent cortical functions 10.9%, and inability to wean-off anesthetic agents 10.9%). The parameters associated with unfavorable outcome were female gender (odds ratio [OR]: 1.45), MAP ≤80 mmHg (OR: 2.57), time to first medical attention >5 h (OR: 127.8), and time to control clinical seizures >3.5 h (OR: 7.87). Almost 44.2% of patients with SE severity score >2 had unfavorable outcome (sensitivity 75% and specificity 45.7%). New scoring system, the CSE outcome score (CSEOS, developed by combining the predictors associated with higher odds of poor outcome), predicted the poor outcome with the sensitivity and specificity of 90% and 54.29%, respectively.Discussion and Conclusion:Low MAP and delay of >3.5 h in treatment initiation or seizure control are the key determinants of poor outcome in CSE. With the incorporation of CSEOS, we believe that our findings can be helpful in the process of clinical decision-making and prognostication of patients with CSE.

Determinants of Outcomes in Convulsive Status Epilepticus: An Observational Study at a Tertiary Care Center in North India

“…The most common type of seizure at presentation in our study was GTCS, while patients with UTCS had the most unfavourable outcome [6]. This is in contrast to the ambispective study conducted by Dani et al, who reported GTCS as a determinant for unfavourable outcomes [3]. A low GCS score at the time of the first assessment (GCS of <=12 in our study) was identified as a significant independent risk factor for an unfavourable outcome.…”

“…Older age at presentation was associated with poor outcomes, and a similar association has been shown in past studies. The cutoff of age with poor outcomes in our study was 36 years; however, the association was not significant [2,3,[11][12][13][14]. While some studies have shown female gender being associated with unfavourable outcomes, the gender of our study patients did not show any significant correlation, although male patients were more in number than female patients [15,16].…”

“…A higher incidence of unfavourable outcomes was seen in individuals with a MAP below 80 mmHg, accounting for 38.46% of cases. Dani et al conducted a prior study that related MAP to presentation and outcomes in patients with convulsive SE [ 3 ]. Previous studies have shown a significant association between STESS and unfavourable outcomes [ 10 , 21 , 23 , 24 ].…”

“…This region faces a combination of viral, metabolic, and structural elements that contribute to seizures, which are further impacted by socioeconomic circumstances, cultural norms, and healthcare accessibility [2]. However, studies specifically focusing on the determinants influencing SE outcomes within this geographical area are limited [3,4]. Understanding the determinants impacting SE outcomes in North India is crucial for several reasons.…”

Factors Associated With Prolonged Length of Stay in Patients Hospitalized With Generalized Convulsive Status Epilepticus in the United States

“…Mortality from GCSE varies between 3 and 39%. [1][2][3][4][5][6][7] As such, GCSE often requires hospital admission and results in major health resource utilization and hospital costs. 8 Characterizing hospitalizations after GCSE is an essential step in curbing fatality rates and healthcare expenditures related to GCSE.…”