From the Clinic for Intensive Care Medicine (S.S., R. Spiegel, K.T., S.M., R. Sutter) and Division of Clinical Neurophysiology, Department of Neurology (S.R., R. Sutter), University Hospital Basel; and University of Basel (D.Y., R. Sutter), Switzerland.
Neurology. 2017 Jul 25;89(4):376-384. doi: 10.1212/WNL.0000000000004147. Epub 2017 Jun 28.
To determine the implications of first responses of emergency medical services (EMS) to out-of-hospital status epilepticus (SE) on outcome.
From 2005 to 2014, prehospital and in-hospital data were assessed in consecutive adults admitted to an academic medical center with out-of-hospital SE. Logistic regression was performed to identify variables with a robust association between missed epileptic events by the EMS and no recovery to functional baseline in survivors.
Among 213 SE patients, 150 were admitted via EMS. While nonconvulsive SE (NCSE) was missed by the EMS in 63.7%, convulsive SE (CSE) was not missed except in 4 patients with transformation into subtle SE. Missed NCSE was more likely with older age (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02-1.10, = 0.003) and no seizure history (OR 6.64, 95% CI 2.43-18.1, < 0.001). The area under the receiver operating characteristic curve for prediction of missed NCSE by these variables was 0.839. Independent predictors for not receiving benzodiazepines were increasing age (OR 1.05, 95% CI 1.01-1.08, = 0.008) and higher Glasgow Coma Scale score (OR 1.21, 95% CI 1.09-1.36, = 0.001). Missed NCSE was independently associated with increased odds for no return to functional baseline in survivors (OR 3.83, 95% CI 1.22-11.98, = 0.021).
Among patients admitted with out-of-hospital SE, CSE is mostly recognized while NCSE is frequently missed especially in patients with increasing age and no seizure history. This calls for heightened awareness for out-of-hospital NCSE in such patients, as missed NCSE is associated with lack of treatment and less recovery to functional baseline in survivors independent of established outcome predictors.
确定急救医疗服务（EMS）对院外癫痫持续状态（SE）的首次反应对结果的影响。
从 2005 年到 2014 年，对连续收治于学术医疗中心的院外 SE 成年患者的院前和院内数据进行评估。采用逻辑回归确定 EMS 漏诊癫痫事件与幸存者未恢复至功能基线之间存在稳健关联的变量。
在 213 例 SE 患者中，150 例通过 EMS 入院。虽然 EMS 漏诊了 63.7%的非惊厥性 SE（NCSE），但除了 4 例转化为轻微 SE 的患者外，并未漏诊惊厥性 SE（CSE）。年长（比值比[OR] 1.06，95%置信区间[CI] 1.02-1.10， = 0.003）和无癫痫发作史（OR 6.64，95%CI 2.43-18.1， ＜0.001）更可能导致 NCSE 漏诊。这些变量预测 NCSE 漏诊的受试者工作特征曲线下面积为 0.839。不接受苯二氮䓬类药物治疗的独立预测因素为年龄增加（OR 1.05，95%CI 1.01-1.08， = 0.008）和格拉斯哥昏迷量表评分较高（OR 1.21，95%CI 1.09-1.36， = 0.001）。NCSE 漏诊与幸存者无法恢复至功能基线的可能性增加独立相关（OR 3.83，95%CI 1.22-11.98， = 0.021）。
在因院外 SE 入院的患者中，CSE 大多得到识别，而 NCSE 则经常漏诊，尤其是在年龄增加且无癫痫发作史的患者中。这就需要提高对这类患者院外 NCSE 的认识，因为漏诊的 NCSE 与治疗不足以及幸存者无法恢复至功能基线独立相关，而这些因素与既定的结局预测因素无关。
