PURPOSE:Characteristics and outcomes of patients admitted with seizures to an ICU are not well described in an inner city minority population. This population presents with unique characteristics that are associated with increased morbidity and mortality in MICU.
METHODS:This is a retrospective observational study of patients admitted with seizures to an academic medical ICU from January 2006 to December 2007 was performed. Study patients were classified based on standard criterion into those with status epilepticus (SE) and those without (Non-SE). Data on demographics, clinical history, laboratory, interventions and outcomes was collected. Predictors of mortality due to seizures were also analyzed. Using stepwise logistic regression odds ratios were calculated and 95% CI are reported. A p-value < 0.05 was considered significant.
RESULTS:Among the 100 study patients, 77 had SE and 7 patients died. (Table 1) Common causes of seizures included non-adherence with anti-epileptic drugs (45%), active substance abuse (36%) and metabolic causes (20%). Among those who died, 6 had SE and 1 Non-SE. Although subjects who died were on prolonged mechanical ventilation (MV) (OR 1.44, 95% CI 1.10–1.89; p < 0.01); race, SE, substance use, non-adherence and need for MV were not associated with death. While comparing those with SE to others (Table -2), SE patients were less likely to have new-onset seizures (OR 0.14 95% CI 0.28–0.73; p=0.02) or active substance abuse (OR 0.22, 95% CI 0.07–0.66; p< 0.01).
CONCLUSION:Although death associated with seizures was not related to any baseline predictor variable except prolonged MV, MICU patients who had SE were found to be at a lower likelihood of having new onset seizures or history of active substance abuse.
CLINICAL IMPLICATIONS:This is probably the largest reported series of patients with seizures in an ICU serving an inner city minority population. This data provides new insights into the risk factors for death and SE among inner city minority MICU patients with seizures.
DISCLOSURE:Raghu Loganathan, None.