Status epilepticus in patients with known epilepsy presenting to the emergency department: Predictors and mortality...

Status epilepticus (SE) is a time-critical neurological emergency associated with significant morbidity and mortality. Data on its burden and predictors among patients with established epilepsy presenting to the emergency department (ED) remain limited, particularly in Asian settings. This study aimed to determine the incidence of SE, its association with in-hospital mortality, and its predictors.

This multicentre prospective observational study was conducted across 34 public hospitals in Malaysia. Epilepsy patients presenting to the ED with seizures were recruited using convenience sampling. The primary endpoints were SE and in-hospital mortality. Predictors were identified using logistic regression analysis.

A total of 521 patients were included, of whom 119 (22.8%) had SE. In-hospital mortality rate was 3.5%. SE was independently associated with mortality (aOR 9.17, 95% CI 3.14-26.78; p < 0.01), along with prior ischaemic stroke (aOR 5.75, 95% CI 2.13-15.56; p = 0.01). Independent predictors of SE included age ≥ 60 years (aOR 1.79, 95% CI 1.03-3.11, p = 0.04), hyperglycaemia (aOR 2.08, 95% CI 1.10-3.91, p = 0.02), hypocalcaemia (aOR 2.50, 95% CI 1.06-5.90, p = 0.04), central nervous system infections (aOR 7.80, 95% CI 2.80-21.78, p < 0.01), and phenytoin use (aOR 1.98, 95% CI 1.16-3.37, p = 0.01).

SE occurred in nearly one-quarter of epilepsy patients presenting to the ED and was strongly associated with increased in-hospital mortality. These findings may assist clinicians in identifying patients at increased risk of SE and support early risk stratification and appropriate monitoring, particularly among older patients and those presenting with metabolic abnormalities or suspected CNS infection.