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Risk factors associated with death in in-hospital pediatric convulsive status epilepticus

Tobias Loddenkemper1, Tanvir U Syed, Sriram Ramgopal

  • 1Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, United States of America.

Plos One
|October 31, 2012
PubMed

Insights

Pediatric convulsive status epilepticus (SE) affects 0.08% of pediatric hospital admissions, with a 1% mortality rate. Risk factors like near drowning and sepsis predict death, while African American ethnicity may reduce risk.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Epidemiology

Background:

  • Convulsive status epilepticus (SE) is a critical neurological emergency in children.
  • Understanding in-patient mortality and its predictors is crucial for improving outcomes in pediatric SE.

Purpose of the Study:

  • To evaluate in-patient mortality rates associated with pediatric convulsive SE.
  • To identify independent predictors of death in children experiencing convulsive SE.

Main Methods:

  • A large, multi-center cohort was identified from the KID Inpatient Database (1997, 2000, 2003, 2006).
  • Convulsive SE cases, associated diagnoses, and in-patient deaths were queried.
  • Univariate and multivariable logistic regression analyses were performed to identify risk factors for mortality.

Main Results:

  • The study identified 12,365 pediatric patients with convulsive SE (0.08% of admissions), with 117 deaths (0.9% mortality).
  • Independent predictors of death included near drowning, hemorrhagic shock, sepsis, prolonged mechanical ventilation, and structural brain lesions.
  • African American ethnicity was associated with a decreased risk of death.

Conclusions:

  • Pediatric convulsive SE has a significant mortality rate, necessitating identification of high-risk patients.
  • Several clinical factors predict mortality, suggesting targets for aggressive management and enhanced monitoring.
  • Further research into protective factors, such as ethnicity, may offer novel therapeutic insights.
Abstract

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