COMPARISONS OF THE MORTALITY AND CLINICAL PRESENTATIONS OF STATUS EPILEPTICUS IN PRIVATE PRACTICE AND UNIVERSITY HOSPITAL SETTINGS IN RICHMOND, VIRGINIA
Abstract number :
2.006
Submission category :
Year :
2003
Submission ID :
2266
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Venkata Jakkampudi, Alan Towne, Elizabeth Waterhouse, Linda Garnett, Dajun Ko, Robert DeLorenzo Neurology, Virginia Commonwealth University, Richmond, VA; Pharmacology and Toxicology and Molecular Biophysics and Biochemistry, Virginia Commonwealth Univers
Status epilepticus (SE) is a major neurological emergency associated with significant morbidity and mortality. Most of the major clinical studies of SE are from large teaching hospitals. It is important to determine if the presentation of SE in the community practice setting has the same morbidity and mortality and clinical presentation as in the major tertiary care centers. This study was initiated to compare the presentation of SE in university and community hospitals in Richmond, VA.
Patients presenting to community and university hospitals in the greater Richmond metropolitan area were prospectively collected over the same time period by the same team of investigators. Data on each case was entered into the SE data base for analysis. Utilizing the same data collection criteria and research staff to obtain information from both community and university hospital settings, greatly improved the reliability and uniformity of the data. Definitions of etiology, seizure type, and risk factors and statistical methods were conducted as described previously (Neurology 1996;46:1029-1035).
The overall mortalities for SE in the community and university hospitals were not statistically significantly different. Despite the tertiary care setting of the university hospitals, the mortality for SE in these two populations was the same. The major etiologies of SE in both clinical settings were very similar with withdrawl from antiepileptic drugs and alcohol, cerebral vascular accidents, and anoxia/hypoxia being the most common etiologies in adults and infections in children. Mortality was the highest in the elderly population in both study groups. The pediatric population in both clinical settings had a very low mortality. Risk factors for outcome were the same for both populations.
This study demonstrates that the clinical presentation of SE in university and community hospitals is very similar. Mortality, age distribution, etiologies, and predictors of outcome were essentially identical in the two populations. Thus, the significant morbidity and mortality observed in the large academic medical centers is not primarily the result of the tertiary care patient population, but rather is mainly determined by the underlying pathophysiology of SE. Community hospitals need to initiate SE protocols and treatment education programs for SE with the same vigor as academic medical centers to achieve favorable outcomes for SE.
[Supported by: NIH-NINDS Grants P50NS25630 and R01NS23350.]