Steven Tobochnik1, Camilo Gutierrez1, Mercedes P Jacobson2. 1. Temple University School of Medicine, Department of Neurology, 3401 North Broad Street, Parkinson Pavilion, Suite C525, Philadelphia, PA 19140, United States. 2. Temple University School of Medicine, Department of Neurology, 3401 North Broad Street, Parkinson Pavilion, Suite C525, Philadelphia, PA 19140, United States. Electronic address: jacobsm@temple.edu.
Abstract
PURPOSE: Seizures are a common cause of presentation to the emergency department (ED) but vary widely in severity and prognostic significance, with some cases requiring ICU management. Most evidence regarding seizure outcomes in the ICU comes from patients exclusively with status epilepticus (SE) or with new seizures detected after ICU admission. To aid in determining early prognosis of ICU patients with and without SE, we performed an analysis of patients initially presenting with any type of seizure and requiring ICU management. METHOD: Analysis of hospital records of 247 consecutive patients presenting to the ED initially with seizure and directly admitted to the ICU between January 2010 and June 2013. The primary outcome was composite in-hospital death or discharge to hospice, and the secondary outcome was recurrent ICU seizures. RESULTS: The primary outcome occurred in 7.7% of patients. Both early mechanical ventilation and an acute intracranial process on neuroimaging were associated with a poor outcome. About half of this cohort presented with SE. Although SE was associated with recurrent seizures in the ICU, the primary outcome was similar between patients presenting with and without SE. Patients with SE had greater rates of early intubation in the ED and were treated more aggressively with medication, whereas patients without SE had greater rates of first ever seizure, acute intracranial disease including intracranial hemorrhage, and neurosurgical intervention. CONCLUSION: Patients presenting to the ED with and without SE requiring ICU admission may have similar acute outcomes, yet differ in risk factors and seizure etiologies.
PURPOSE:Seizures are a common cause of presentation to the emergency department (ED) but vary widely in severity and prognostic significance, with some cases requiring ICU management. Most evidence regarding seizure outcomes in the ICU comes from patients exclusively with status epilepticus (SE) or with new seizures detected after ICU admission. To aid in determining early prognosis of ICU patients with and without SE, we performed an analysis of patients initially presenting with any type of seizure and requiring ICU management. METHOD: Analysis of hospital records of 247 consecutive patients presenting to the ED initially with seizure and directly admitted to the ICU between January 2010 and June 2013. The primary outcome was composite in-hospital death or discharge to hospice, and the secondary outcome was recurrent ICU seizures. RESULTS: The primary outcome occurred in 7.7% of patients. Both early mechanical ventilation and an acute intracranial process on neuroimaging were associated with a poor outcome. About half of this cohort presented with SE. Although SE was associated with recurrent seizures in the ICU, the primary outcome was similar between patients presenting with and without SE. Patients with SE had greater rates of early intubation in the ED and were treated more aggressively with medication, whereas patients without SE had greater rates of first ever seizure, acute intracranial disease including intracranial hemorrhage, and neurosurgical intervention. CONCLUSION:Patients presenting to the ED with and without SE requiring ICU admission may have similar acute outcomes, yet differ in risk factors and seizure etiologies.