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

Tobias Loddenkemper; Tanvir U Syed; Sriram Ramgopal; Deepak Gulati; Sikawat Thanaviratananich; Sanjeev V Kothare; Amer Alshekhlee; Mohamad Z Koubeissi

doi:10.1371/journal.pone.0047474

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

Journal article

Open access

Peer reviewed

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

Tobias Loddenkemper, Tanvir U Syed, Sriram Ramgopal, Deepak Gulati, Sikawat Thanaviratananich, Sanjeev V Kothare, Amer Alshekhlee and Mohamad Z Koubeissi

PloS one, Vol.7(10), pp.e47474-e47474

2012

DOI: 10.1371/journal.pone.0047474

PMCID: PMC3482185

PMID: 23110074

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Abstract

To evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE) in a large, multi-center, pediatric cohort. 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. We identified 12,365 (5,541 female) patients with convulsive SE aged 0-20 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] 4.4-426.8), hemorrhagic shock (OR 17.83; CI 6.5-49.1), sepsis (OR 10.14; CI 4.0-25.6), massive aspiration (OR 9.1; CI 1.8-47), mechanical ventilation >96 hours (OR9; 5.6-14.6), transfusion (OR 8.25; CI 4.3-15.8), structural brain lesion (OR7.0; CI 3.1-16), hypoglycemia (OR5.8; CI 1.75-19.2), sepsis with liver failure (OR 14.4; CI 5-41.9), and admission in December (OR3.4; CI 1.6-4.1). African American ethnicity (OR 0.4; CI 0.2-0.8) was associated with a decreased risk of death in SE. 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.

Confidence Intervals

Shock, Hemorrhagic - complications

Humans

Risk Factors

Child, Preschool

Infant

Male

Sepsis - complications

Hospitalization

Inpatients - statistics & numerical data

Status Epilepticus - mortality

Respiration, Artificial - adverse effects

Hypoglycemia - complications

Female

Status Epilepticus - epidemiology

Odds Ratio

Child

Details

Title: Subtitle: Risk factors associated with death in in-hospital pediatric convulsive status epilepticus
Creators: Tobias Loddenkemper - Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, United States of America
Tanvir U Syed
Sriram Ramgopal
Deepak Gulati
Sikawat Thanaviratananich
Sanjeev V Kothare
Amer Alshekhlee
Mohamad Z Koubeissi
Resource Type: Journal article
Publication Details: PloS one, Vol.7(10), pp.e47474-e47474
DOI: 10.1371/journal.pone.0047474
PMID: 23110074
PMCID: PMC3482185
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: Public Library of Science; United States
Grant note: 1R21NS076859-01 / NINDS NIH HHS 1 RC1 HL099749-01 / NHLBI NIH HHS R21 NS076859 / NINDS NIH HHS RC1 HL099749 / NHLBI NIH HHS HL-09-001 / NHLBI NIH HHS
Language: English
Date published: 2012
Academic Unit: Neurology
Record Identifier: 9984020800002771

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