Authors :
Presenting Author: Emily Mello, BS – Weill Cornell Medical College
Karen Acker, MD – Weill Cornell Medicine; Carmela Bacani, BS – NewYork-Presbyterian/Weill Cornell Medicine; Alan Wu, MS – Weill Cornell Medicine; Natasha Basma, MPH – Weill Cornell Medicine; Zachary Grinspan, MD, MS – Weill Cornell Medicine
Rationale:
Convulsive Status Epilepticus (CSE) is a neurologic emergency that requires prompt treatment, as delays are associated with increased mortality. Understanding temporal patterns in pediatric CSE and possible correlations to viral epidemiology could provide an opportunity to enhance situational awareness, hasten time to treatment, and improve patient outcomes, in addition to providing insight into possible infectious etiologies. As respiratory viral infections are known to exhibit seasonal patterns, this study explores possible correlations between ED admissions for pediatric CSE and respiratory viral trends.
Methods:
Emergency department (ED) visits for pediatric CSE at a tertiary academic medical center in New York City from 2016 through 2022 were identified using a modified version of a previously developed computable phenotype (Hess-Homeier et al., 2020; Epilepsia), which we validated using electronic medical records from our own institution. CSE events per month were visualized graphically (Figure 1). We conducted a time series analysis (QS-test and kw-test) to detect whether a seasonal effect could explain some of the variation in CSE events per month. Positive respiratory viral panel results (bioMérieux, Inc.) obtained between 2016 and 2022 were visually compared to CSE trends to identify individual viruses with similar seasonal patterns (Figure 2). Graphs and analyses were generated using R version 4.0.1.
Results:
Our computable phenotype identified 523 ED visits for pediatric CSE: 59 in 2016, 49 in 2017, 69 in 2018, 47 in 2019, 89 in 2020, 114 in 2021, and 96 in 2022. Monthly cases of CSE demonstrated peaks during the summer months, with 11 visits in June 2016, 13 in July 2018, and 10 in July 2019, similar to Parainfluenza 3 Virus, which exhibited repeated summer peaks during 2016 through 2019, although not statistically significant in a time series analysis. During 2020-2022, peaks occurred in December 2020 (14 cases), November 2021 (21 cases) and January 2022 (14 cases).
Conclusions:
This preliminary data provides a comparison of temporal patterns in CSE and respiratory viral disease and highlights changes in pediatric CSE patterns that may be explained by the profound social disruption of the COVID-19 pandemic. Analysis involving a larger dataset is warranted to better explore CSE seasonality and further characterize the relationship between pediatric CSE and viral infection.
Funding:
This investigation was supported by grant UL1TR002384 of the Clinical and Translational Science Center at Weill Cornell Medical College.
References:
Hess-Homeier DL, Parikh K, Basma N, Vella AE, Grinspan ZM. Automated identification and quality measurement for pediatric convulsive status epilepticus. Epilepsia. 2021 Feb;62(2):337-346. doi: 10.1111/epi.16795. Epub 2020 Dec 20. PMID: 33341928.