OUTCOME VARIABLES OF STATUS EPILEPTICUS IN A PEDIATRIC INTENSIVE CARE UNIT

Objectives: To determine unfavorable outcome variables of children in Status Epilepticus (SE) presenting to a Canadian Pediatric Intensive Care Unit (PICU).

Methods: Charts of patients <18yrs presenting in SE to the PICU over the past 10 years were audited after ethics approval. Patient outcome before PICU discharge was categorized as 'Favorable' for return to prestatus level of functioning or 'Unfavorable' for the development of a new deficit or death. Besides demographics and etiology of SE, data was analyzed at 3 care points: Transport, Emergency Department (ED) and PICU for management, complications, and length of PICU stay. The effect the patient's proximity to a PICU was also evaluated using the patient's postal code of origin with 'Regional' patients with transport time <30 minutes and 'Outreach' with longer transport times. Statistical analysis was performed by the Student t-test and Kruskal-Wallis test for normal and skewed continuous variables respectively and Chi-square test or Fisher exact test for categorical variables. p<0.05 was significant.

Results: 180 patients were identified with a median age of 1.9yrs with 54% males. 69% patients were identified as proximal to a PICU. Idiopathic SE had the highest incidence while infectious/vascular etiologies caused more unfavorable outcome. SE refractory to standard management in ED had a higher incidence of death (p<0.05). Patients with unfavorable outcome had longer transport times (p=0.08), higher incidence of apnea during transport (p=0.01), higher duration of hospital stay (p<0.05), incidence of therapeutic coma (p=0.01), duration of therapeutic coma (p<0.05) and duration of mechanical ventilation (p<0.05), recurrent or refractory seizures in hospital (p<0.05 each). There was no difference in outcome based on the PICU shift of admission. The 'Outreach' group with unfavorable outcome had a significantly higher incidence of cerebral edema (p<0.05) and SIADH (p<0.05).

Conclusion: Multivariate analysis of outcome variables in SE demonstrate that cerebral edema, renal failure, teaching unit patients, seizures refractory to ED treatment and apnea during transport are factors that may lead to unfavorable outcome of SE.