Impact of treatment on the short-term prognosis of status epilepticus in two population-based cohorts.
OBJECTIVE
Epidemiological surveys on status epilepticus (SE) in adults in two Italian areas (Bologna and Lugo di Romagna) disclosed a major difference in 30-day case fatality (33% versus 7 %). Since suboptimal management was hypothesised in the first site, we compared the quality of treatment in the two cohorts and examined its contribution to prognosis.


METHODS
The Bologna and Lugo di Romagna cohorts of adults with incident SE were included. Patients with post-anoxic encephalopathy were excluded. Quality of treatment was independently classified by two experts. Clinical and treatment features were compared in the two sites. The contribution of variables collected to the 30-day case fatality was explored through multivariate logistic analysis in the whole group of patients.


RESULTS
Fifty-seven patients were included. No differences were observed between Bologna and Lugo di Romagna either in clinical features or the time of management. The quality of global drug treatment significantly differed in disfavour of Bologna (p = 0.044). Independent predictors of a worse 30-day case fatality in the whole group of patients were the onset of SE in hospital (OR 9.67, p = 0.0095) and the poor global quality of treatment (partially correct versus correct OR 3.59, p = 0.55, and incorrect versus correct OR 21.09, p = 0.0084). By subgroup analysis, the site of onset factor encompasses the aetiologic background of patients.


CONCLUSIONS
In addition to previously known prognostic factors, epidemiological comparison of mortality rates of SE between different regions must also consider the quality of treatment.
Vignatelli
Luca
L
Dipartimento di Scienze Neurologiche, Università di Bologna, Via Ugo Foscolo n. 7, Bologna, Italy. vigna@interfree.it
Rinaldi
Rita
R
Baldin
Elisa
E
Tinuper
Paolo
P
Michelucci
Roberto
R
Galeotti
Massimo
M
de Carolis
Piero
P
D'Alessandro
Roberto
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004569:Electroencephalography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011787:Quality of Health Care; D012307:Risk Factors; D012424:Rural Population; D013226:Status Epilepticus / Q000401:mortality / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014505:Urban Population