Management and prognosis of status epilepticus according to hospital setting: a prospective study.
BACKGROUND
The treatment of status epilepticus (SE) is based on relatively little evidence although several guidelines have been published. A recent study reported a worse SE prognosis in a large urban setting as compared to a peripheral hospital, postulating better management in the latter. The aim of this study was to analyse SE episodes occurring in different settings and address possible explanatory variables regarding outcome, including treatment quality.


METHODS
Over six months we prospectively recorded consecutive adults with SE (fit lasting five or more minutes) at the Centre Hospitalier Universitaire Vaudois (CHUV) and in six peripheral hospitals (PH) in the same region. Demographical, historical and clinical variables were collected, including SE severity estimation (STESS score) and adherence to Swiss SE treatment guidelines. Outcome at discharge was categorised as "good" (return to baseline), or "poor" (persistent neurological sequelae or death).


RESULTS
Of 54 patients (CHUV: 36; PH 18), 33% had a poor outcome. Whilst age, SE severity, percentage of SE episodes lasting less than 30 minutes and total SE duration were similar, fewer patients had a good outcome at the CHUV (61% vs 83%; OR 3.57; 95% CI 0.8-22.1). Mortality was 14% at the CHUV and 5% at the PH. Most treatments were in agreement with national guidelines, although less often in PH (78% vs 97%, P = 0.04).


CONCLUSIONS
Although not statistically significant, we observed a slightly worse SE prognosis in a large academic centre as compared to smaller hospitals. Since SE severity was similar in the two settings but adherence to national treatment guidelines was higher in the academic centre, further investigation on the prognostic role of SE treatment and outcome determinants is required.
Rossetti
Andrea O
AO
Service de Neurologie, CHUV, Lausanne, Switzerland. andrea.rossetti@chuv.ch
Novy
Jan
J
Ruffieux
Christiane
C
Olivier
Philippe
P
Foletti
Giovanni B
GB
Hayoz
Daniel
D
Burnand
Bernard
B
Logroscino
Giancarlo
G
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006767:Hospitals, District; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
D000927:Anticonvulsants