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Single Center Outcomes of Status Epilepticus at a Paediatric Intensive Care Unit
Samir Shah1, Namrata Shah2, Robert Johnson3
11Departments of Paediatric Critical Care Medicine,University of Tennessee Health Science Center and Le Bonheur Children's Hospital,Memphis,TN,USA.
Insights
Refractory seizures in pediatric patients admitted to the pediatric intensive care unit (PICU) for status epilepticus (SE) are linked to poorer outcomes. Identifying unfavorable outcome variables is crucial for improving care in pediatric SE cases.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Epileptology
Background:
- Status epilepticus (SE) is a common reason for admission to pediatric intensive care units (PICUs).
- Outcomes for pediatric patients experiencing SE are highly variable.
- This study audited the experience of SE patients at a Canadian PICU to identify factors associated with unfavorable outcomes.
Purpose of the Study:
- To determine variables associated with unfavorable outcomes in pediatric patients presenting with status epilepticus (SE) to a pediatric intensive care unit (PICU).
- To analyze patient data across different care points: transport, emergency department (ED), and PICU.
Main Methods:
- A 10-year retrospective audit of patient charts for individuals under 18 years old admitted with SE.
- Data analysis included Student's t-test, Kruskal-Wallis test for continuous variables, and Chi-square or Fisher's exact test for categorical variables.
- Outcomes were categorized as favorable (return to baseline function) or unfavorable (new deficit/death).
Main Results:
- 189 patients were included; idiopathic SE was most common.
- Infectious/vascular etiologies and progression to refractory SE in the ED were linked to worse outcomes.
- Unfavorable outcomes were associated with apnea during transport, longer hospital stays, need for therapeutic coma, mechanical ventilation, and recurrent/refractory seizures.
Conclusions:
- Refractory seizures in pediatric patients with SE are a significant predictor of adverse outcomes in the PICU.
- Factors such as renal failure, cerebral edema, and transport-related apnea also contribute to unfavorable outcomes.
Background:
Status epilepticus (SE) is a frequent admission diagnosis to paediatric intensive care units (PICUs) and is associated with variable outcomes. We have audited our experience of patients presenting in SE at a Canadian PICU to determine unfavorable outcome variables.
Methods:
Charts of patients <18 years of age presenting in SE to a tertiary care PICU over a 10-year period were audited. Data were analyzed at three care-points: transport, the emergency department (ED) and the PICU. Patient outcome before PICU discharge was categorized as "favorable" for return to pre-status functioning level or "unfavorable" for new deficit/death. Student's t-test and the Kruskal-Wallis test were used for analysis of normal and skewed continuous variables, respectively, and either Chi-square test or Fisher's exact test for categorical variables.
Results:
189 patients (54% males) were identified with a median age of 1.9 years. Idiopathic SE had the highest incidence; infectious/vascular etiologies were associated with more unfavorable outcomes. Progression to refractory SE in the ED had a higher incidence of death (p<0.05). Patients with an unfavorable outcome had a higher incidence of apnea during transport (p=0.01), longer hospital stays (p<0.05), need for therapeutic coma (p=0.01), longer duration of therapeutic coma (p<0.05), need for mechanical ventilation (p<0.05), and recurrent or refractory seizures during inpatient stay (p<0.05). Multivariate analysis of unfavorable outcomes of patients in SE presenting to the PICU included renal failure, cerebral edema, apnea during transport, refractory seizures, and recurrent seizures.
Conclusions:
Refractory seizures in children presenting with SE are associated with worsened outcomes in the PICU.
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