The Prevalence and Impact of Status Epilepticus Secondary to Intracerebral Hemorrhage: Results from the US Nationwide Inpatient Sample.

BACKGROUND

Status epilepticus (SE) has been identified as a predictor of morbidity and mortality in many acute brain injury patient populations. We aimed to assess the prevalence and impact of SE after intracerebral hemorrhage (ICH) in a large patient sample to overcome limitations in previous small patient sample studies.

METHODS

We queried the Nationwide Inpatient Sample for patients admitted for ICH from 1999 to 2011, excluding patients with other acute brain injuries. Patients were stratified into SE diagnosis and no SE diagnosis cohorts. We identified independent risk factors for SE and assessed the impact of SE on morbidity and mortality with multivariable logistic regression models. Logistic regression was used to evaluate the trend in SE diagnoses over time as well.

RESULTS

SE was associated with significantly increased odds of both mortality and morbidity (odds ratios (OR) 1.18 [confidence intervals (CI) 1.01-1.39], and OR 1.53 [CI 1.22-1.91], respectively). Risk factors for SE included female sex (OR 1.17 [CI 1.01-1.35]), categorical van Walraven score (vWr 5-14: OR 1.68 [CI 1.41-2.01]; vWr > 14: OR 3.77 [CI 2.98-4.76]), sepsis (OR 2.06 [CI 1.58-2.68]), and encephalopathy (OR 3.14 [CI 2.49-3.96]). Age was found to be associated with reduced odds of SE (OR 0.97 [CI 0.97-0.97]). From 1999 to 2011, prevalence of SE diagnosis increased from 0.25 to 0.61% (p < 0.001). Factors associated with SE were female sex, medium and high risk vWr score, sepsis, and encephalopathy. Independent predictors associated with increased mortality from SE were increased age, pneumonia, myocardial infarction, cardiac arrest, and sepsis.

CONCLUSIONS

SE is a significant, likely underdiagnosed, predictor of morbidity and mortality after ICH. Future studies are necessary to better identify which patients are at highest risk of SE to guide resource utilization.