title: Risk factors associated with death in in-hospital pediatric convulsive status epilepticus.
abstract: OBJECTIVE
  To evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE) in a large, multi-center, pediatric cohort.
  
  
  METHODS
  We identified our cohort from the KID Inpatient Database for the years 1997, 2000, 2003 and 2006. We queried the database for convulsive SE, associated diagnoses, and for inpatient death. Univariate logistic testing was used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariable logistic regression procedure. P-values less than 0.05 were taken as significant.
  
  
  RESULTS
  We identified 12,365 (5,541 female) patients with convulsive SE aged 0-20 years (mean age 6.2 years, standard deviation 5.5 years, median 5 years) among 14,965,571 pediatric inpatients (0.08%). Of these, 117 died while in the hospital (0.9%). The most frequent additional admission ICD-9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure. Independent risk factors for death in patients with SE, assessed by multivariate calculation, included near drowning (Odds ratio [OR] 43.2; Confidence Interval [CI] 4.4-426.8), hemorrhagic shock (OR 17.83; CI 6.5-49.1), sepsis (OR 10.14; CI 4.0-25.6), massive aspiration (OR 9.1; CI 1.8-47), mechanical ventilation >96 hours (OR9; 5.6-14.6), transfusion (OR 8.25; CI 4.3-15.8), structural brain lesion (OR7.0; CI 3.1-16), hypoglycemia (OR5.8; CI 1.75-19.2), sepsis with liver failure (OR 14.4; CI 5-41.9), and admission in December (OR3.4; CI 1.6-4.1). African American ethnicity (OR 0.4; CI 0.2-0.8) was associated with a decreased risk of death in SE.
  
  
  CONCLUSIONS
  Pediatric convulsive SE occurs in up to 0.08% of pediatric inpatient admissions with a mortality of up to 1%. There appear to be several risk factors that can predict mortality. These may warrant additional monitoring and aggressive management.
authors.affiliation: Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Tanvir U
authors.initials: TU
authors.lastname: Syed
authors.forename: Sriram
authors.initials: S
authors.lastname: Ramgopal
authors.forename: Deepak
authors.initials: D
authors.lastname: Gulati
authors.forename: Sikawat
authors.initials: S
authors.lastname: Thanaviratananich
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
authors.forename: Amer
authors.initials: A
authors.lastname: Alshekhlee
authors.forename: Mohamad Z
authors.initials: MZ
authors.lastname: Koubeissi
mesh_terms: D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012771:Shock, Hemorrhagic / Q000150:complications; D013226:Status Epilepticus / Q000453:epidemiology / Q000401:mortality*