Vincent Alvarez1, Jong Woo Lee2, M Brandon Westover2, Frank W Drislane2, Jan Novy2, Mohamed Faouzi2, Nicola A Marchi2, Barbara A Dworetzky2, Andrea O Rossetti2. 1. From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland. vincent.alvarez@hopitalvs.ch. 2. From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Abstract
OBJECTIVE: Our aim was to analyze and compare the use of therapeutic coma (TC) for refractory status epilepticus (SE) across different centers and its effect on outcome. METHODS: Clinical data for all consecutive adults (>16 years) with SE of all etiologies (except postanoxic) admitted to 4 tertiary care centers belonging to Harvard Affiliated Hospitals (HAH) and the Centre Hospitalier Universitaire Vaudois (CHUV) were prospectively collected and analyzed for TC details, mortality, and duration of hospitalization. RESULTS: Two hundred thirty-six SE episodes in the CHUV and 126 in the HAH were identified. Both groups were homogeneous in demographics, comorbidities, SE characteristics, and Status Epilepticus Severity Score (STESS); TC was used in 25.4% of cases in HAH vs 9.75% in CHUV. After adjustment, TC use was associated with younger age, lower Charlson Comorbidity Index, increasing SE severity, refractory SE, and center (odds ratio 11.3 for HAH vs CHUV, 95% confidence interval 2.47-51.7). Mortality was associated with increasing Charlson Comorbidity Index and STESS, etiology, and refractory SE. Length of stay correlated with STESS, etiology, refractory SE, and use of TC (incidence rate ratio 1.6, 95% confidence interval 1.22-2.11). CONCLUSIONS: Use of TC for SE treatment seems markedly different between centers from the United States and Europe, and did not affect mortality considering the whole cohort. However, TC may increase length of hospital stay and related costs. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with SE, TC does not significantly affect mortality. The study lacked the precision to exclude an important effect of TC on mortality.
OBJECTIVE: Our aim was to analyze and compare the use of therapeutic coma (TC) for refractory status epilepticus (SE) across different centers and its effect on outcome. METHODS: Clinical data for all consecutive adults (>16 years) with SE of all etiologies (except postanoxic) admitted to 4 tertiary care centers belonging to Harvard Affiliated Hospitals (HAH) and the Centre Hospitalier Universitaire Vaudois (CHUV) were prospectively collected and analyzed for TC details, mortality, and duration of hospitalization. RESULTS: Two hundred thirty-six SE episodes in the CHUV and 126 in the HAH were identified. Both groups were homogeneous in demographics, comorbidities, SE characteristics, and Status Epilepticus Severity Score (STESS); TC was used in 25.4% of cases in HAH vs 9.75% in CHUV. After adjustment, TC use was associated with younger age, lower Charlson Comorbidity Index, increasing SE severity, refractory SE, and center (odds ratio 11.3 for HAH vs CHUV, 95% confidence interval 2.47-51.7). Mortality was associated with increasing Charlson Comorbidity Index and STESS, etiology, and refractory SE. Length of stay correlated with STESS, etiology, refractory SE, and use of TC (incidence rate ratio 1.6, 95% confidence interval 1.22-2.11). CONCLUSIONS: Use of TC for SE treatment seems markedly different between centers from the United States and Europe, and did not affect mortality considering the whole cohort. However, TC may increase length of hospital stay and related costs. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with SE, TC does not significantly affect mortality. The study lacked the precision to exclude an important effect of TC on mortality.
Authors: Vincent Alvarez; Jong Woo Lee; Frank W Drislane; M Brandon Westover; Jan Novy; Barbara A Dworetzky; Andrea O Rossetti Journal: Epilepsia Date: 2015-07-03 Impact factor: 5.864
Authors: Robert Silbergleit; Valerie Durkalski; Daniel Lowenstein; Robin Conwit; Arthur Pancioli; Yuko Palesch; William Barsan Journal: N Engl J Med Date: 2012-02-16 Impact factor: 91.245
Authors: Wolfgang G Muhlhofer; Stephen Layfield; Daniel Lowenstein; Chee Paul Lin; Robert D Johnson; Shalini Saini; Jerzy P Szaflarski Journal: Epilepsia Date: 2019-04-07 Impact factor: 5.864
Authors: David G Vossler; Jacquelyn L Bainbridge; Jane G Boggs; Edward J Novotny; Tobias Loddenkemper; Edward Faught; Marta Amengual-Gual; Sarah N Fischer; David S Gloss; Donald M Olson; Alan R Towne; Dean Naritoku; Timothy E Welty Journal: Epilepsy Curr Date: 2020-08-21 Impact factor: 7.500
Authors: Michael A Pizzi; Prasuna Kamireddi; William O Tatum; Jerry J Shih; Daniel A Jackson; William D Freeman Journal: J Intensive Care Date: 2017-08-08
Authors: Henrikas Vaitkevicius; Aatif M Husain; Eric S Rosenthal; Jonathan Rosand; Wendell Bobb; Kiran Reddy; Michael A Rogawski; Andrew J Cole Journal: Ann Clin Transl Neurol Date: 2017-04-26 Impact factor: 4.511