title: High prevalence of nonconvulsive and subtle status epilepticus in an ICU of a tertiary care center: a three-year observational cohort study.
abstract: BACKGROUND
  Status epilepticus is one of the most important neurological emergencies and requires immediate therapy and admission to the intensive care unit. We hypothesized that nonconvulsive and subtle status epilepticus are more frequent than reported.
  
  
  METHODS
  This observational cohort study describes types, courses, duration, length of hospital stay, outcome and case fatality rate of status epilepticus in adults in relation to demographic and clinical variables. It was conducted in an intensive care unit of a tertiary care center over three years.
  
  
  RESULTS
  111 status epilepticus episodes had a median duration of 48h. Hospitalization length was 18±15.3 days. 81% of the status epilepticus episodes were nonconvulsive and subtle. Case fatality rate was 17%. Age over 70 years had independent positive influence on status epilepticus course (OR: 5.135; p=0.0029). Hospital stay increased by 1.13h with each additional hour of status epilepticus (p=0.02). Subtle status epilepticus was a risk factor for refractoriness (p=0.0065).
  
  
  CONCLUSIONS
  Prevalence of nonconvulsive and subtle status epilepticus was higher than reported, emphasising the importance of clinical awareness. Older age was associated with more favorable course. This unexpected and contradictory result has to be taken into account during therapeutic interventions in the elderly and should warn from early resignation regarding treatment.
authors.affiliation: Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Switzerland.
authors.forename: Diana
authors.initials: D
authors.lastname: Rudin
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.forename: Stephan
authors.initials: S
authors.lastname: Rüegg
authors.forename: Raoul
authors.initials: R
authors.lastname: Sutter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D004569:Electroencephalography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013226:Status Epilepticus / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000927:Anticonvulsants