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Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus
Objective: To evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE) in a large, multi-center, pediatric cohort. Patients and Methods: We identified our cohort from the KID Inpatient Database for the years 1997, 2000, 2003 and 2006. We queried the database for convulsive SE, associated diagnoses, and for inpatient death. Univariate logistic testing was used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariable logistic regression procedure. P-values less than 0.05 were taken as significant. Results: We identified 12,365 (5,541 female) patients with convulsive SE aged 0β20 years (mean age 6.2 years, standard deviation 5.5 years, median 5 years) among 14,965,571 pediatric inpatients (0.08%). Of these, 117 died while in the hospital (0.9%). The most frequent additional admission ICD-9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure. Independent risk factors for death in patients with SE, assessed by multivariate calculation, included near drowning (Odds ratio [OR] 43.2; Confidence Interval [CI] 4.4β426.8), hemorrhagic shock (OR 17.83; CI 6.5β49.1), sepsis (OR 10.14; CI 4.0β25.6), massive aspiration (OR 9.1; CI 1.8β47), mechanical ventilation >96 hours (OR9; 5.6β14.6), transfusion (OR 8.25; CI 4.3β15.8), structural brain lesion (OR7.0; CI 3.1β16), hypoglycemia (OR5.8; CI 1.75β19.2), sepsis with liver failure (OR 14.4; CI 5β41.9), and admission in December (OR3.4; CI 1.6β4.1). African American ethnicity (OR 0.4; CI 0.2β0.8) was associated with a decreased risk of death in SE. Conclusion: Pediatric convulsive SE occurs in up to 0.08% of pediatric inpatient admissions with a mortality of up to 1%. There appear to be several risk factors that can predict mortality. These may warrant additional monitoring and aggressive management
Univariate calculations of hospital and demographic data from the KID database.
<p>Univariate calculations of hospital and demographic data from the KID database.</p
Univariate calculations of complications and comorbidities from the KID database.
<p>ICD-9 β International Classification of Disease, 9th edition, RSV β respiratory syncytial virus.</p
Selected historical studies of status epilepticus with salient findings.
<p>AED β antiepileptic drug; SE β status epilepticus; CNS β central nervous system; ICU β intensive care unit; RSV β respiratory syncytial virus.</p