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Therapeutic coma (TC) use for status epilepticus (SE) varied significantly between US and European hospitals. While TC did not impact overall mortality, it was linked to longer hospital stays.

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Area of Science:

  • Neurology
  • Critical Care Medicine

Background:

  • Status epilepticus (SE) is a medical emergency requiring prompt treatment.
  • Therapeutic coma (TC) is an established treatment for refractory SE.
  • Variations in TC utilization exist across different healthcare centers.

Purpose of the Study:

  • To compare the utilization of therapeutic coma (TC) for status epilepticus (SE) between US and European tertiary care centers.
  • To analyze the effect of TC on mortality and hospitalization duration in SE patients.

Main Methods:

  • Prospective data collection from 4 tertiary care centers (2 Harvard Affiliated Hospitals - HAH, 2 Centre Hospitalier Universitaire Vaudois - CHUV).
  • Analysis included 236 SE episodes (CHUV) and 126 (HAH) in adults (>16 years), excluding postanoxic SE.
  • Data on TC use, mortality, and length of stay were assessed, controlling for demographics, comorbidities, and SE severity (STESS).

Main Results:

  • TC was used more frequently in HAH (25.4%) compared to CHUV (9.75%).
  • TC use was associated with younger age, fewer comorbidities, increased SE severity, refractory SE, and center.
  • Mortality correlated with comorbidities (Charlson Comorbidity Index), SE severity (STESS), etiology, and refractory SE.
  • TC use was associated with a 1.6-fold increased length of hospital stay (IRR 1.6, 95% CI 1.22-2.11).

Conclusions:

  • Significant differences in TC utilization for SE exist between US and European centers.
  • TC did not significantly affect overall mortality in the studied cohort (Class III evidence).
  • TC use may be associated with increased hospital length of stay and associated costs.