Generalized convulsive status epilepticus after nontraumatic subarachnoid hemorrhage: the nationwide inpatient sample.
OBJECTIVE
To identify the frequency of and impact on outcome of generalized convulsive status epilepticus (GCSE) among patients with nontraumatic subarachnoid hemorrhage (SAH).


METHODS
We used the Nationwide Inpatient Sample, a database of admissions to nonfederal United States hospitals between 1994 and 2002, for this study. From this database, we identified all adult patients with nontraumatic SAH who were admitted through the emergency department. Independent predictors of GCSE and mortality were identified using multivariate logistic regression. Multivariate linear regression analysis was used to determine whether GCSE was independently associated with increased cost and/or duration of hospitalization.


RESULTS
Among the 29,998 patients hospitalized with nontraumatic SAH, GCSE was reported to occur in 0.2% of patients (N = 73 patients). GCSE occurred more frequently among those in the youngest tertiale (49 years old or younger; odds ratio, 3.2; 95% confidence interval, 2.0-5.1), those with renal disease (odds ratio, 4.8; 95% confidence interval, 2.6-8.8), and those who did not undergo a neurosurgical procedure involving a craniotomy (odds ratio, 2.2; 95% confidence interval, 1.3-3.8). GCSE was independently associated with higher in-hospital mortality (48% versus 33% of patients; odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P = 0.002) and longer (9 versus 7 days; P = 0.016) and more expensive (US $39,677 versus US $26,686; P = 0.007) hospitalizations.


CONCLUSIONS
GCSE rarely complicates SAH; however, it is associated with increased patient mortality, length of hospital stay, and cost. GCSE occurs more frequently in young patients, those with a history of renal disease, and patients who do not undergo a craniotomy.
Claassen
Jan
J
Division of Stroke and Critical Care Neurology and Comprehensive Epilepsy Center, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. jc1439@columbia.edu
Bateman
Brian T
BT
Willey
Joshua Z
JZ
Inati
Sarah
S
Hirsch
Lawrence J
LJ
Mayer
Stephan A
SA
Sacco
Ralph L
RL
Schumacher
H Christian
HC
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D013226:Status Epilepticus / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology