Comparisons of the mortality and clinical presentations of status epilepticus in private practice community and university hospital settings in Richmond, Virginia

Abstract

We prospectively compared the clinical course of 119 patients treated for status epilepticus (SE) in private practice community hospitals and 344 SE patients treated in the VCU university hospitals in Richmond, Virginia USA over a 2-year period to test the hypothesis that SE presents with the same mortality and clinical patterns in both clinical settings. Of the patients reviewed, the major etiologies for SE were cerebrovascular disease, decreased anti-epileptic drug levels in epileptic patients, anoxia-hypoxia, and remote symptomatic. The other etiologies included were alcohol related, trauma, central nervous system infections, tumors, systemic infection, metabolic disorders, idiopathic, and hemorrhage. These observations provide the first direct prospective comparison of SE present in university and private practice community hospital settings in the same geographic area. Mortality was the highest in the elderly population while the pediatric population had low mortality in both clinical settings. Etiology risk factors for outcome were similar for both the populations. The data also suggest that the higher degree of illness severity in university hospitals may be associated with a higher incidence of SE, but not with mortality or a different clinical presentation of the condition. The results of this study demonstrate that SE has the same mortality and is present in an essentially identical manner in university and private practice community hospitals and underscores the fact that mortality in SE is not just associated with tertiary care hospitals and the importance of recognizing the severity of SE in the private practice setting.

Figure 1

Number of pediatric and adult patients and their age distribution presenting with SE in private practice community and university hospital. A. 344 patients presented with SE at the university hospital while 119 SE patients presented at private practice community hospitals. The pediatric SE population was higher at the university hospital. B and C. Both hospital settings had similar age distributions for patients from infancy to elderly. The highest number of patients occurred in the elderly (60–79) age group in both populations.

Figure 2

Mortality during and after SE for private practice community and university hospitals. A. Overall mortality 31% and 27% in the private practice community and university hospital populations respectively, which were not significantly different from each other. The majority of mortality from SE occurred after SE in both populations. B. Mortality curves for patients with SE in the private practice community and university populations. Percent mortality from the cessation of SE following successful treatment to 30 days after SE was plotted. Mortality time curves were almost identical for both the populations with the majority of deaths occurring in the first 2-weeks after SE. Twenty days after SE the mortality rates leveled off, indicating that the majority of SE related deaths had reached a plateau.

Figure 3

Age distribution and mortality for private practice community and university hospitals. The data present the number of patients in the database plotted against age groups. The elderly population exhibited the highest mortality (> 40%) while the pediatric population had a low level of mortality in both hospital settings. The overall mortality for the pediatric population in the university settings was less than 5%.

Figure 4

Seizure duration and mortality outcome for private practice community and university hospitals. The database was divided into patients who seized from 30–60 minutes (non-prolonged SE) and patients who seized for >60 minutes (prolonged SE). Mortality for the non-prolonged SE group was 8% and 7% respectively while the mortality for the prolonged SE group was 37% and 35% respectively in the private practice community and university hospital settings.

Figure 5

Adult etiologies for SE in the university and private practice community population. The data represent the number of patients in each category of etiology for the database (multiple etiologies are included for some patients). The major etiologies of SE in both clinical settings were very similar in the two populations.

Figure 6

Etiologies of adult patients with SE and mortality in the university and private practice community population. The data give the number of patients in each category of etiology for the database (multiple etiologies are included for some patients). The mortalities for each of the major etiologies were very similar in the two populations.