Full-Length Original Research
Mortality and recovery from refractory status epilepticus in the intensive care unit: A 7-year observational study
Article first published online: 7 JAN 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 54, Issue 3, pages 502–511, March 2013
How to Cite
Sutter, R., Marsch, S., Fuhr, P. and Rüegg, S. (2013), Mortality and recovery from refractory status epilepticus in the intensive care unit: A 7-year observational study. Epilepsia, 54: 502–511. doi: 10.1111/epi.12064
- Issue published online: 4 MAR 2013
- Article first published online: 7 JAN 2013
- Manuscript Accepted: 31 OCT 2012
- Research Funds
- Scientific Society
- Novartis Foundation, Novartis, and Roche
- Scientific Society
- Gottfried Julia Bangerter-Rhyner Foundation
- Swiss National Science Foundation
- Swiss Parkinson's Disease Society
- ossweiler Foundation
- Mach-Gaensslen Foundation
- Botnar Foundation
- Refractory status epilepticus;
- Hypoxic encephalopathy;
- Brain tumor;
- Neurocritical care
Refractory status epilepticus (RSE) is a life-threatening neurologic emergency with high mortality and morbidity. The aim of this study was to identify and quantify associations between clinical characteristics of adult RSE patients and outcome.
Comprehensive medical chart review was performed of all consecutive adult RSE patients treated on the intensive care units of an academic tertiary care center between 2005 and 2011. Demographics, RSE etiologies and duration, comorbidities, as well as outcomes were assessed. Associations between clinical characteristics and death were quantified.
Of 260 patients with status epilepticus, 111 developed RSE. Hypoxic encephalopathy (23%), brain tumors (14%), known and uncontrolled epilepsy (10%), and ischemic stroke (8%) were the main etiologies. During hospitalization 38% of patients died. Hypoxic encephalopathy (HE) and brain tumors were independently associated with death (relative risk [RR] 2.41, 95% confidence interval [CI] 1.40–4.12; p = 0.001 and RR 2.81, 95%CI 1.59–4.96; p < 0.0001). The estimated hazard ratio of death was 3.1 (95% CI1.6–6.0; p = 0.001) for patients with HE and 1.1 (95% CI 0.5–2.3; p = 0.745) for patients with brain tumors. RSE duration and nonconvulsive status epilepticus in coma were independently associated with death (for every hour RR 1.001; 95%CI 1.00–1.002; p = 0.011 and RR 3.62; 95%CI 1.34–9.77; p = 0.005).
Brain tumors and HE had high relative risks for death and were independently associated with mortality in our cohort of critically ill RSE patients. Other clinical characteristics, as well as the use of intravenous anesthetic drugs and mechanical ventilation, may not be strongly related to outcome and should therefore be used cautiously for informed decision making regarding treatment.