Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr-Jun;20(2):142-148.
doi: 10.4103/aian.AIAN_369_16.

Predictors of Outcome in Children with Status Epilepticus during Resuscitation in Pediatric Emergency Department: A Retrospective Observational Study

Indumathy Santhanam  1 , Sangeetha Yoganathan  2 , V Akila Sivakumar  3 , Rubini Ramakrishnamurugan  1 , Sharada Sathish  4 , Murali Thandavarayan  1
Affiliations

Predictors of Outcome in Children with Status Epilepticus during Resuscitation in Pediatric Emergency Department: A Retrospective Observational Study

Indumathy Santhanam et al. Ann Indian Acad Neurol. 2017 Apr-Jun.

Abstract

Objectives: To study the clinical profile and predictors of outcome in children with status epilepticus (SE) during resuscitation in pediatric emergency department.

Materials and methods: This retrospective study was carried out in a tertiary care teaching hospital. Admission and resuscitation data of children, aged between 1 month and 12 years, treated for SE, between September 2013 and August 2014, were extracted using a standard data collection form. Our SE management protocol had employed a modified pediatric assessment triangle to recognize and treat acute respiratory failure, cardiovascular dysfunction (CD), and subtle SE until all parameters resolved. Continuous positive airway pressure, fluid boluses based on shock etiology, inotropes, and cardiac safe anticonvulsants were the other modifications. Risk factors predicting mortality during resuscitation were analyzed using univariate and penalized logistic regression.

Results: Among 610 who were enrolled, 582 (95.4%) survived and 28 (4.6%) succumbed. Grunt odds ratio (OR): 3.747 (95% confidence interval [CI]: 1.035-13.560), retractions OR: 2.429 (95% CI: 1.036-5.698), rales OR: 10.145 (95% CI: 4.027-25.560), prolonged capillary refill time OR: 3.352 (95% CI: 1.339-8.388), and shock requiring >60 mL/kg fluids OR: 2.439 (95% CI 1.040-5.721) were associated with 2-3 times rise in mortality. Inappropriate prehospital treatment and CD were the significant predictors of mortality OR: 7.82 (95% CI 2.10-29.06) and 738.71 (95% CI: 97.11-999), respectively. Resolution of CD was associated with improved survival OR: 0.02 (95% CI: 0.003-0.17).

Conclusion: Appropriate prehospital management and treatment protocol targeting resolution of CD during resuscitation could reduce mortality in children with SE.

Keywords: Cardiovascular dysfunction; Pediatric assessment triangle; prehospital care; status epilepticus.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Modified status epilepticus protocol for the management of children with convulsive and subtle status epilepticus in our pediatric emergency department NGT = Nasogastric tube, IV = Intravenous, IO = Intraosseous, NS = Normal saline, CSE = Convulsive status epilepticus, SSE = Subtle status epilepticus, FOS = Fosphenytoin, GTCS = Generalized tonic–clonic seizures, N = Normal, Abn = Abnormal, AWD = Acute watery diarrhea, BP = Blood pressure, MAP = Mean arterial pressure, RR = Respiratory rate, WOB = Work of breathing, PERL = Pupils equal and reacting to light, ET = Endotracheal tube
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • [Paediatric Life Support].
    Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. Van de Voorde P, et al. Notf Rett Med. 2021;24(4):650-719. doi: 10.1007/s10049-021-00887-9. Epub 2021 Jun 2. Notf Rett Med. 2021. PMID: 34093080 Free PMC article. Review. German.

References

    1. Santhanam I, Pai M, Kasturi K, Radhamani MP. Mortality after admission in the pediatric emergency department: A prospective study from a referral children's hospital in Southern India. Pediatr Crit Care Med. 2002;3:358–63. - PubMed
    1. Santhanam I, Sangareddi S, Venkataraman S, Kissoon N, Thiruvengadamudayan V, Kasthuri RK. A prospective randomized controlled study of two fluid regimens in the initial management of septic shock in the emergency department. Pediatr Emerg Care. 2008;24:647–55. - PubMed
    1. Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. 2007;51:447–55. - PubMed
    1. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Crit Care. 2012;16:212. - PMC - PubMed
    1. Santhanam I, editor. Pediatric Emergency Medicine Course. 2nd ed. New Delhi: JAYPEE Brothers; 2013. Status epilepticus; pp. 198–212.