title: Status epilepticus: impact of therapeutic coma on outcome.
abstract: OBJECTIVE
  Therapeutic coma is advocated in guidelines for management of refractory status epilepticus; this is, however, based on weak evidence. We here address the specific impact of therapeutic coma on status epilepticus outcome.
  
  
  METHODS
  Retrospective assessment of a prospectively collected cohort.
  
  
  METHODS
  Academic hospital.
  
  
  METHODS
  Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013.
  
  
  RESULTS
  We recorded prospectively demographics, clinical status epilepticus features, treatment, and outcome at discharge and retrospectively medical comorbidities, hospital stay, and infectious complications. Associations between potential predictors and clinical outcome were analyzed using multinomial logistic regressions. Of 467 patients with incident status epilepticus, 238 returned to baseline (51.1%), 162 had new disability (34.6%), and 67 died (14.3%); 50 subjects (10.7%) were managed with therapeutic coma. Therapeutic coma was associated with poorer outcome in the whole cohort (relative risk ratio for new disability, 6.86; 95% CI, 2.84-16.56; for mortality, 9.10; 95% CI, 3.17-26.16); the effect was more important in patients with complex partial compared with generalized convulsive or nonconvulsive status epilepticus in coma. Prevalence of infections was higher (odds ratio, 3.81; 95% CI, 1.66-8.75), and median hospital stay in patients discharged alive was longer (16 d [range, 2-240 d] vs 9 d [range, 1-57 d]; p < 0.001) in subjects managed with therapeutic coma.
  
  
  CONCLUSIONS
  This study provides class III evidence that therapeutic coma is associated with poorer outcome after status epilepticus; furthermore, it portends higher infection rates and longer hospitalizations. These data suggest caution in the straightforward use of this approach, especially in patients with complex partial status epilepticus.
authors: 1Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Lausanne, Switzerland. 2Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
authors: Nicola A
authors: NA
authors: Marchi
authors: Jan
authors: J
authors: Novy
authors: Mohamed
authors: M
authors: Faouzi
authors: Christine
authors: C
authors: Stähli
authors: Bernard
authors: B
authors: Burnand
authors: Andrea O
authors: AO
authors: Rossetti
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D013226:Status Epilepticus / Q000628:therapy*; D013997:Time Factors; D014474:Unconsciousness / Q000139:chemically induced*