Abstracts

RATIONALE: Status epilepticus (SE) is a significant risk factor for death among inpatients with stroke; the increased risk of death among those with SE and stroke is independent of the size of the infarct (Waterhouse, et.al., 1998). Using data from the National Inpatient Sample of the Healthcare Cost and Utilization Project (NIS, HCUP-3), we recently reported that SE increases the odds of death among a sample of 161,524 inpatients, even after controlling for multiple confounding variables (Trevathan, 2002). In order to study the impact of early diagnosis and timely treatment of SE among inpatients, it is important to identify sub-populations of inpatients at increased risk of death from SE. [At the end of this activity the participant will be able to discuss the relationship between SE and the risk of death among inpatients with subarachnoid hemorrhage (SAH).]
METHODS: We used NIS, HCUP-3 data from 1988-97 to ascertain discharge records with a diagnosis of SAH (ICD-9=430). Neonates were excluded. The NIS contains more than 65 million patient discharge reports that represent a systematic 20% sample of USA hospital discharges. Descriptive analyses were performed, and unadjusted odds ratios were calculated using in-hospital death as the primary outcome variable and SE as the primary exposure variable. Multiple logistic regression models were developed using Stata 7.0, entering variables in a step-wise fashion that were both clinically relevant co-morbid conditions and potential confounding variables based upon univariate analysis.
RESULTS: 44,914 discharge records (37.1% male) with a diagnosis of SAH were ascertained; 121 discharge records also had a diagnosis of SE. 62% of patients with SAH were between 26 and 65 years of age. The overall case fatality rate among those with SAH was 30.1%; those with SAH and SE had a case fatality rate of 40.7 %. SE increased the odds of death among those with SAH (unadjusted OR=1.64; 95% CI=1.14, 2.36). In the logistic regression model the most significant predictor of death was cerebral anoxia (adjusted OR=9.7; 95% CI= 7.6, 12.5). Respiratory failure, cerebral edema, intracerebral hemorrhage, ketoacidosis, and hypernatremia were also significant risk factors for death. After adjusting for co-morbid conditions (39 variables in the final model), SE significantly increased the odds of death among those with SAH (adjusted OR=1.69; 95% CI=1.08, 2.63).
CONCLUSIONS: SE increases the risk of death among inpatients with SAH, after controlling simultaneously for multiple co-morbid conditions.
[Supported by: 1 RO3 HS11453-01 (ET) from the Agency for Healthcare Research & Quality.]