title: Management of status epilepticus in neurological versus medical intensive care unit: does it matter?
abstract: BACKGROUND
  Admission of patients with status epilepticus (SE) to the neurosciences intensive care unit (NICU) may improve management and outcomes compared to general ICUs.
  
  
  METHODS
  We reviewed all patients with SE admitted to the NICU versus the Medical ICU in our institution between 2005 and 2008. We included only patients with definite or probable SE based on pre-defined criteria. We collected demographic and clinical data, including severity of admission scores and adjusted short-term outcomes for admission and management in the two ICUs.
  
  
  RESULTS
  There were 168 visits in 151 patients for definite or probable SE, 46 (27 %) of which were in the NICU and 122 (73 %) in the MICU. APACHE II scores were significant higher in the MICU group (17.5 vs 13.4, p = 0.003) and age in the NICU (58.3 vs 51.5 years, p = 0.041). More continuous EEGs were ordered in the NICU (85 vs 30 %, p < 0.001), where fewer patients were intubated, but more eventually tracheostomized. The NICU had a higher rate of complex partial SE and more alert or somnolent patients, whereas the MICU had a higher rate of generalized SE and more stuporous or comatose patients. Admission diagnoses also differed, with the NICU having higher rate of strokes and the MICU higher rate of toxometabolic etiologies (39 vs 12 % and 11 vs 21 %, p = 0.002). After adjustment, no difference was found in mortality, the ICU or hospital length of stay and modified Rankin score at discharge.
  
  
  CONCLUSIONS
  SE treatment revealed increased use of continuous EEG in NICU-admitted patients, but without concomitant reduction in LOS or discharge outcomes compared to the MICU.
authors.affiliation: Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA. varelas@neuro.hfh.edu
authors.forename: Panayiotis N
authors.initials: PN
authors.lastname: Varelas
authors.forename: Jesse
authors.initials: J
authors.lastname: Corry
authors.forename: Mohammed
authors.initials: M
authors.lastname: Rehman
authors.forename: Tamer
authors.initials: T
authors.lastname: Abdelhak
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.forename: Marianna
authors.initials: M
authors.lastname: Spanaki
authors.forename: James
authors.initials: J
authors.lastname: Bartscher
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods* / Q000458:organization & administration*; D004569:Electroencephalography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013226:Status Epilepticus / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*