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

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.

Prevalence, Aetiology and Outcome of Status Epilepticus in Children with Convulsions at the Wesley Guild Hospital, Ilesa

“…The presence of hypoglycaemia is found to be significantly associated with the risk of death in this study. This is in agreement with the finding by Idro et al [8] in Kenya and Loddenkemper et al in US [31]. A third, 33.3% of the children in this study developed neurologic deficits [31].…”

“…This is in agreement with the finding by Idro et al [8] in Kenya and Loddenkemper et al in US [31]. A third, 33.3% of the children in this study developed neurologic deficits [31]. This high morbidity rate is similar to 33% found in Korea children and 56.3% in India [38].…”

“…Status epilepticus has been found to be significantly associated with risk of developing neurological sequelae and death. Mortality is also closely related to the cause of the status epilepticus [12,20,21,25,31]. The neurologic deficits found in this study were regression of the attained developmental milestones in six (46.4%) of the children.…”

“…The mortality rates reported from the developed countries ranging from 0-3% is much lower than that obtained in this study [21]. The outcome of status epilepticus is still poor in Nigeria and in sub-Saharan Africa due to several factors [17,29,31,35,36]. The higher mortality rates in these resource poor countries may be attributed to delays in accessing treatment and lack of skills and facilities such as intensive care units, infusion pumps and ventilators, unorthodox cultural practices before presentation in the hospitals and poor infrastructure, prevalence of parasitic diseases, non-availability of appropriate and effective drugs [10,16,19,23,29,30,37].…”

“…The prevalence of status epilepticus in London is 18-20/100,000/year a rate similar to that in other developing countries [17,24]. Another paediatric inpatients data-based study from the US reported a prevalence of 0.08% [31]. The prevalence of status epilepticus in subSaharan is higher than that of other continents such as Europe and America.…”