Abstracts

Rationale: Convulsive status epilepticus (CSE) often accompanies fever in children, and febrile CSE (FCSE) is related to neurological sequela. However, there is limited data of demographics and risk factors for neurological sequela in pediatric patients with FCSE. The aim of this study was to describe demographics and risk factors for poor outcome among children with FCSE. Methods: We created a retrospective cohort of FCSE episodes in patients admitted to pediatric intensive care unit at Kobe Children's Hospital. We included patients who: 1) were 1 month to 15 years of age, 2) had a convulsive seizure or a sequence of intermittent seizures lasting 30 minutes or longer without fully regaining consciousness, 3) had fever (≥38.0°C) within 24 h before and after the seizure onset, and 4) were admitted between October 2002 and December 2013. To clarify the effect of seizure with fever itself, hypoxic ischemic encephalopathy, traumatic brain injury, malignancy, and pleocytosis (>8/μL) were excluded because these conditions affected the outcome by itself. When a patient had more than one FCSE episode, only the first episode was included for the analysis. The neurological performances at baseline before admission and at discharge were assessed using the Pediatric Cerebral Performance Category scale (PCPC). Cases that PCPC at discharge were higher than at baseline were defined as a poor outcome, and cases PCPC at discharge were the same as the baseline were defined as a good outcome. Results: A total of 253 patients (128 males) with a median (p25-p75) age at onset of 27 (17-63) months were enrolled. In past medical history, 190 (75%) patients were neurologically healthy, 51 (20%) patients had intellectual disabilities, and 37 (15%) patients had a history of epilepsy. The median temperature on admission was 38.8 (38.1-39.6) °C. The median seizure duration was 72 (48-145) min. Eighty-two (33%) patients required intubation. Benzodiazepine was infused to 212 (84%) patients, and barbiturate was infused to 59 (23%) patients. EEG was performed in 111 (44%) patients, and non-convulsive seizure was seen in 22 (9%) patients. A head CT scan was performed in 226 (89%) patients on admission, and 46 (18%) had abnormalities, including a: baseline abnormality in 23 (9%), and new abnormality in 23 (9%). Three (1%) patients died during hospitalization, and 32 (13%) patients resulted in poor outcome. The poor outcome was significantly correlated with higher temperature on admission (χ² test, p = 0.03), longer seizure duration (χ² test, p = 0.03), prolonged unconsciousness (χ² test, p < 0.001), and presence of non-convulsive seizure (χ² test, p < 0.001). Outcomes did not differ significantly between age, sex, neurological medical history, and head CT scan abnormality on admission. Conclusions: Among pediatric patients with FCSE, the mortality rate was 1%, and neurological worsening rate was 13% during hospitalization. The poor outcome was correlated with higher temperature on admission, longer seizure duration, prolonged unconsciousness, and non-convulsive seizure.