RESUMO
OBJECTIVE: Determination of the real-world performance of a health care system in the treatment of status epilepticus (SE). METHODS: Prospective, multicenter population-based study of SE in Auckland, New Zealand (NZ) over 1 year, with data recorded in the EpiNet database. Focus on treatment patterns and determinants of SE duration and 30-day mortality. The incidence, etiology, ethnic discrepancies, and seizure characteristics of this cohort have been published previously. RESULTS: A total of 365 patients were included in this treatment cohort; 326 patients (89.3%) were brought to hospital because of SE, whereas 39 patients (10.7%) developed SE during a hospital admission for another reason. Overall, 190 (52.1%) had a known history of epilepsy and 254 (70.0%) presented with SE with prominent motor activity. The mean Status Epilepticus Severity Score (STESS) was 2.15 and the mean SE duration of all patients was 44 min. SE self-terminated without any treatment in 84 patients (22.7%). Earlier administration of appropriately dosed benzodiazepine in the pre-hospital setting was a major determinant of SE duration. Univariate analysis demonstrated that mortality was significantly higher in older patients, patients with longer durations of SE, higher STESS, and patients who developed SE in hospital, but these did not maintain significance with multivariate analysis. There was no difference in the performance of the health care system in the treatment of SE across ethnic groups. SIGNIFICANCE: When SE was defined as 10 continuous minutes of seizure, overall mortality was lower than expected and many patients had self-limited presentations for which no treatment was required. Although there were disparities in the incidence of SE across ethnic groups there was no difference in treatment or outcome. The finding highlights the benefit of a health care system designed to deliver universal health care.
Assuntos
Anticonvulsivantes , Estado Epiléptico , Humanos , Estado Epiléptico/epidemiologia , Estado Epiléptico/terapia , Estado Epiléptico/mortalidade , Estado Epiléptico/tratamento farmacológico , Masculino , Feminino , Nova Zelândia/epidemiologia , Pessoa de Meia-Idade , Adulto , Idoso , Estudos Prospectivos , Anticonvulsivantes/uso terapêutico , Adolescente , Adulto Jovem , Resultado do Tratamento , Estudos de Coortes , Idoso de 80 Anos ou mais , Criança , Pré-EscolarRESUMO
OBJECTIVE: Although disparities have been described in epilepsy care, their contribution to status epilepticus (SE) and associated outcomes remains understudied. METHODS: We used the 2010-2019 National Inpatient Sample to identify SE hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM codes. SE prevalence was stratified by demographics. Logistic regression was used to assess factors associated with electroencephalographic (EEG) monitoring, intubation, tracheostomy, gastrostomy, and mortality. RESULTS: There were 486 861 SE hospitalizations (2010-2019), primarily at urban teaching hospitals (71.3%). SE prevalence per 10 000 admissions was 27.3 for non-Hispanic (NH)-Blacks, 16.1 for NH-Others, 15.8 for Hispanics, and 13.7 for NH-Whites (p < .01). SE prevalence was higher in the lowest (18.7) compared to highest income quartile (18.7 vs. 14, p < .01). Older age was associated with intubation, tracheostomy, gastrostomy, and in-hospital mortality. Those ≥80 years old had the highest odds of intubation (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.43-1.58), tracheostomy (OR = 2, 95% CI = 1.75-2.27), gastrostomy (OR = 3.37, 95% CI = 2.97-3.83), and in-hospital mortality (OR = 6.51, 95% CI = 5.95-7.13). Minority populations (NH-Black, NH-Other, and Hispanic) had higher odds of tracheostomy and gastrostomy compared to NH-White populations. NH-Black people had the highest odds of tracheostomy (OR = 1.7, 95% CI = 1.57-1.86) and gastrostomy (OR = 1.78, 95% CI = 1.65-1.92). The odds of receiving EEG monitoring rose progressively with higher income quartile (OR = 1.47, 95% CI = 1.34-1.62 for the highest income quartile) and was higher for those in urban teaching compared to rural hospitals (OR = 12.72, 95% CI = 8.92-18.14). Odds of mortality were lower (compared to NH-Whites) in NH-Blacks (OR = .71, 95% CI = .67-.75), Hispanics (OR = .82, 95% CI = .76-.89), and those in the highest income quartiles (OR = .9, 95% CI = .84-.97). SIGNIFICANCE: Disparities exist in SE prevalence, tracheostomy, and gastrostomy utilization across age, race/ethnicity, and income. Older age and lower income are also associated with mortality. Access to EEG monitoring is modulated by income and urban teaching hospital status. Older adults, racial/ethnic minorities, and populations of lower income or rural location may represent vulnerable populations meriting increased attention to improve health outcomes and reduce disparities.
Assuntos
Disparidades em Assistência à Saúde , Mortalidade Hospitalar , Estado Epiléptico , Humanos , Masculino , Feminino , Idoso , Estado Epiléptico/mortalidade , Estado Epiléptico/terapia , Estado Epiléptico/epidemiologia , Pessoa de Meia-Idade , Disparidades em Assistência à Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Adulto , Estados Unidos/epidemiologia , Adulto Jovem , Prevalência , Hospitalização/estatística & dados numéricos , Adolescente , Morbidade/tendências , Eletroencefalografia , Traqueostomia/estatística & dados numéricosRESUMO
OBJECTIVE: This study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic. METHODS: We performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anonymised Information Linkage databank. We identified PWE living in Wales during the study "pandemic period" (January 1, 2020-June 30, 2021) and during a "prepandemic" period (January 1, 2016-December 31, 2019). We compared prepandemic health care utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on children (<18 years old), older people (>65 years old), those with intellectual disability, and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios (RRs). RESULTS: We identified 27 279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7), and outpatient attendance (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2, and 87.0) in the prepandemic period. Hospital and epilepsy-related hospital admissions, and emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. RRs [95% confidence intervals (CIs)] for pandemic versus prepandemic periods were .70 [.69-.72], .77 [.73-.81], .78 [.77-.79], and .80 [.79-.81]. The corresponding rates also reduced for PWOE. New epilepsy diagnosis rates decreased during the pandemic compared with the prepandemic period (2.3/100 000/month cf. 3.1/100 000/month, RR = .73, 95% CI = .68-.78). Both all-cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RR = 1.07, 95% CI = .997-1.145 and RR = 2.44, 95% CI = 2.12-2.81). When removing COVID deaths, RRs were .88 (95% CI = .81-.95) and 1.29 (95% CI = 1.08-1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78-1.15). SIGNIFICANCE: All-cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer term effects of the decrease in new epilepsy diagnoses and health care utilization and increase in deaths associated with epilepsy need further research.
Assuntos
COVID-19 , Epilepsia , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , Epilepsia/epidemiologia , Epilepsia/mortalidade , Feminino , Masculino , Estudos Retrospectivos , Idoso , Adolescente , Criança , Adulto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem , País de Gales/epidemiologia , Pré-Escolar , Estado Epiléptico/mortalidade , Estado Epiléptico/epidemiologia , Hospitalização/estatística & dados numéricos , Lactente , Pandemias , Serviço Hospitalar de Emergência/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/mortalidade , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: Understanding factors driving variation in status epilepticus outcomes would be critical to improve care. We evaluated the degree to which patient and hospital characteristics explained hospital-to-hospital variability in intubation and postacute outcomes. METHODS: This was a retrospective cohort study of Medicare beneficiaries admitted with status epilepticus between 2009 and 2019. Outcomes included intubation, discharge to a facility, and 30- and 90-day readmissions and mortality. Multilevel models calculated percent variation in each outcome due to hospital-to-hospital differences. RESULTS: We included 29 150 beneficiaries. The median age was 68 years (interquartile range [IQR] = 57-78), and 18 084 (62%) were eligible for Medicare due to disability. The median (IQR) percentages of each outcome across hospitals were: 30-day mortality 25% (0%-38%), any 30-day readmission 14% (0%-25%), 30-day status epilepticus readmission 0% (0%-3%), 30-day facility stay 40% (25%-53%), and intubation 46% (20%-61%). However, after accounting for many hospitals with small sample size, hospital-to-hospital differences accounted for 2%-6% of variation in all unadjusted outcomes, and approximately 1%-5% (maximally 8% for 30-day readmission for status epilepticus) after adjusting for patient, hospitalization, and/or hospital characteristics. Although many characteristics significantly predicted outcomes, the largest effect size was cardiac arrest predicting death (odds ratio = 10.1, 95% confidence interval = 8.8-11.7), whereas hospital characteristics (e.g., staffing, accreditation, volume, setting, services) all had lesser effects. SIGNIFICANCE: Hospital-to-hospital variation explained little variation in studied outcomes. Rather, certain patient characteristics (e.g., cardiac arrest) had greater effects. Interventions to improve outcomes after status epilepticus may be better focused on individual or prehospital factors, rather than at the inpatient systems level.
Assuntos
Hospitais , Readmissão do Paciente , Estado Epiléptico , Humanos , Estado Epiléptico/terapia , Estado Epiléptico/mortalidade , Idoso , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estados Unidos/epidemiologia , Hospitais/estatística & dados numéricos , Medicare/estatística & dados numéricos , Estudos de Coortes , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Idoso de 80 Anos ou mais , Resultado do TratamentoRESUMO
Objetivos: El objetivo del estudio es comparar, entre dos grupos de pacientes, una serie de factores cl¡nico-epidemiol¢gicos relacionados a mortalidad: edad, sexo, comorbilidades, tipo de estatus epilptico y uso deventilaci¢n mec nica. Material y Mtodos: El estudio se realiz¢ en el Hospital Cayetano Heredia entre enero de 2012 hasta diciembre de 2014. Incluy¢ 94 pacientes con el diagnóstico de estatus epilptico admitidos durante el per¡odo establecido. El estudio compar¢ datos de los supervivientes contra datos de los fallecidos. Se recolect¢ la información de las historias cl¡nicas en una ficha de datos para la elaboraci¢n de una base de datos. Resultados: La mortalidad intrahospitalaria fue de 8,51%. La media de edad fue de 41,8 a¤os. Las principales etiolog¡as halladas fueron la epilepsia idiop tica (28,72%), la neurocisticercosis (14,89%) y la enfermedad cerebrovascular(14,89%). Se encontr¢ que un 19,5% de pacientes hab¡an abandonado el tratamiento antiepilptico. El an lisisbivariado demostr¢, para la mortalidad intrahospitalaria, una relaci¢n significativa (p<0,05) con un alto Õndice de Comorbilidad Charlson y el uso de ventilaci¢n mec nica. Conclusiones: La presencia de comorbilidades y el uso deventilaci¢n mec nica se relacionan significativamente con mortalidad en pacientes con estatus epiléptico.
Objectives: The goal of this study is to compare, among two groups of patients, a series of clinical-epidemiologicalfactors related to mortality: age, sex, comorbidity, type of status epilepticus and use of mechanical ventilation.Material and Methods: The study was carried out in the Hospital Cayetano Heredia from January 2012 to December2014. It includes 94 patients with status epilepticus admitted during the established period. The study compareddata from the survivors against data from the deceased. Information from medical records was collected in a Data Sheet to elaborate a data bank. Results: In-hospital mortality was 8.51%. The mean of age was 41,8 a¤os. Themain etiologies found were idiopathic epilepsy (28.72%), neurocysticercosis (14.89%) and cerebrovascular disease(14.89%). It was found that 19.5% of patients had discontinued antiepileptic treatment. Bivariate analysis showed,for in-hospital lethality, a significant relationship (p<0.05) with a high Charlson Index and the use of mechanical ventilation. Conclusions: The presence of comorbidities and the use of mechanical ventilation are significantlyrelated with in-hospital mortality in patients with status epilepticus.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Comorbidade , Estado Epiléptico , Estado Epiléptico/epidemiologia , Estado Epiléptico/mortalidade , Neurocisticercose , Respiração Artificial/mortalidade , Estudos Retrospectivos , Relatos de CasosRESUMO
Objective Status epilepticus (SE) is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications. .
Objetivos Status epilepticus (SE) está associado com morbidade e mortalidade importantes. Diversos estudos avaliaram determinantes de prognóstico relacionados com SE, havendo controvérsias neste sentido. O objetivo deste estudo foi avaliar mortalidade no SE e seus fatores determinantes. Método Estudo prospectivo, em Ribeirão Preto, incluiu 105 pacientes, entre fevereiro e dezembro de 2000. Mortalidade foi definida como óbito no período de internação hospitalar. Resultados O índice de mortalidade foi de 36.2%, superior ao verificado em estudos prévios. Em análise univariada, mortalidade foi associada com idade, antecedente de epilepsia, presença de crises focais complexas, etiologia, recorrência e refratariedade do SE, presença de complicações clínicas e classificação focal do SE. Em análise multivariada, a ocorrência de complicações clínicas relacionou-se significativamente com prognóstico. Conclusões Em nossa amostra, a mortalidade foi mais elevada do que previamente descrito na literatura, não relacionada com idade, etiologia ou duração do SE, mas, em análise multivariada, com complicações médicas durante o tratamento. .
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Mortalidade Hospitalar , Estado Epiléptico/mortalidade , Fatores Etários , Brasil/epidemiologia , Métodos Epidemiológicos , Hospitais Universitários , Tempo de Internação , Prognóstico , Recidiva , Fatores Sexuais , Estado Epiléptico/etiologia , Estado Epiléptico/fisiopatologia , Centros de Atenção TerciáriaRESUMO
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estado Epiléptico/mortalidade , Fatores Etários , Anticonvulsivantes/uso terapêutico , Eletroencefalografia , Midazolam/uso terapêutico , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Convulsões/fisiopatologia , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/fisiopatologia , Resultado do TratamentoRESUMO
Se denomina estado de mal epiléptico, a una crisis epiléptica o a una sucesión subintrante de crisis, que persiste por más de 30 minutos, sin volver a un estado de conciencia intercrítico. Es una situación de emergencia, de grave riesgo para la vida y la integridad del cerebro del paciente, por lo que debe emprenderse un tratamiento rápido y eficaz. Este término no sólo incluye las crisis de gran mal, pero es necesario reconocer que las crisis convulsivas tónicos y/o clónicas son las más peligrosas. En el presente artículo se van a revisar los aspectos epidemiológicos, etiológicos, fisiopatológicos, clínicos y de manejo del estado de mal convulsivo
Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Humanos , Estado Epiléptico/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Estado Epiléptico/epidemiologia , Estado Epiléptico/etiologia , Estado Epiléptico/fisiopatologia , Estado Epiléptico/mortalidade , PrognósticoRESUMO
Por informaçöes obtidas no Serviço de Arquivo Médico e Estatístico do Hospital Juliano Moreira, Bahia, procedeu-se a um estudo descritivo de aspectos epidemiológicos do status epilepticus num período de 50 anos (1930-1979). Foram estabelecidos coeficientes de mortalidade proporcional e analisou-se a distribuiçäo da doença segundo sexo em relaçäo ao ano e década. Os resultados obtidos permitem orientar as seguintes conclusöes: A) Nos primeiros anos após a introduçäo do Luminal observou-se um aumento da mortalidade proporcional vindo a descrever em seguida. B) O sexo masculino é o mais afetado. C) Há uma maior resistência e/ou menor exposiçäo do sexo feminino
Assuntos
Humanos , Masculino , Feminino , Estado Epiléptico/mortalidade , Hospitais PsiquiátricosRESUMO
Através de informaçöes obtidas no Serviço de Arquivo Médico e Estatístico do Hospital Juliano Moreira, Bahia, procedeu-se um estudo descritivo de aspectos epidemiológicos do status epilepticus - num período de 50 anos (1930-1979). Foram estabelecidos coeficientes de mortalidade específica e analisou-se a distribuiçäo da doença segundo sexo em relaçäo ao ano e década. Os resultados obtidos permitem orientar as seguintes conclusöes: a. Nos primeiros anos após a introduçäo do luminal observou-se um aumento da mortalidade específica vindo a decrescer em seguida; b. O sexo masculino é o mais afetado; c. Há uma maior resistência e/ou menor exposiçäo do sexo feminino