Therapeutic coma for status epilepticus: Differing practices in a prospective multicenter study.
OBJECTIVE
Our aim was to analyze and compare the use of therapeutic coma (TC) for refractory status epilepticus (SE) across different centers and its effect on outcome.


METHODS
Clinical data for all consecutive adults (>16 years) with SE of all etiologies (except postanoxic) admitted to 4 tertiary care centers belonging to Harvard Affiliated Hospitals (HAH) and the Centre Hospitalier Universitaire Vaudois (CHUV) were prospectively collected and analyzed for TC details, mortality, and duration of hospitalization.


RESULTS
Two hundred thirty-six SE episodes in the CHUV and 126 in the HAH were identified. Both groups were homogeneous in demographics, comorbidities, SE characteristics, and Status Epilepticus Severity Score (STESS); TC was used in 25.4% of cases in HAH vs 9.75% in CHUV. After adjustment, TC use was associated with younger age, lower Charlson Comorbidity Index, increasing SE severity, refractory SE, and center (odds ratio 11.3 for HAH vs CHUV, 95% confidence interval 2.47-51.7). Mortality was associated with increasing Charlson Comorbidity Index and STESS, etiology, and refractory SE. Length of stay correlated with STESS, etiology, refractory SE, and use of TC (incidence rate ratio 1.6, 95% confidence interval 1.22-2.11).


CONCLUSIONS
Use of TC for SE treatment seems markedly different between centers from the United States and Europe, and did not affect mortality considering the whole cohort. However, TC may increase length of hospital stay and related costs.


METHODS
This study provides Class III evidence that for patients with SE, TC does not significantly affect mortality. The study lacked the precision to exclude an important effect of TC on mortality.
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland. vincent.alvarez@hopitalvs.ch.
Vincent
V
Alvarez
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Jong Woo
JW
Lee
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
M Brandon
MB
Westover
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Frank W
FW
Drislane
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Jan
J
Novy
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Mohamed
M
Faouzi
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Nicola A
NA
Marchi
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Barbara A
BA
Dworetzky
From the Department of Neurology (V.A.), Hôpital du Valais, Sion; Department of Clinical Neurosciences (V.A., J.N., N.A.M., A.O.R.) and Institute of Social and Preventive Medicine (M.F.), CHUV and University of Lausanne, Switzerland; Department of Neurology, Brigham and Women's Hospital (V.A., J.W.L., B.A.D.), Department of Neurology, Massachusetts General Hospital (M.B.W.), and Department of Neurology, Beth Israel Deaconess Medical Center (F.W.D.), Harvard Medical School, Boston, MA; and Department of Clinical Neurosciences (N.A.M.), Geneva University Hospitals, Switzerland.
Andrea O
AO
Rossetti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000139:chemically induced*; D015897:Comorbidity; D000069279:Drug Resistant Epilepsy / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000150:complications / Q000401:mortality / Q000628:therapy*; D013557:Switzerland; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
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