Abstracts

Children requiring admission to a paediatric intensive care unit (PICU) for CSE may represent children with the most severe forms of CSE. Thus, identification of factors associated with admission to PICU for CSE may provide some insight into determinants of severity of CSE, the likelihood of refractory CSE, and facilitate the development of appropriate strategies to improve the outcome of CSE. We now report factors associated with admission to PICU for CSE. Subjects were enrolled as part of the North London convulsive STatus EPilepticus in childhood Surveillance Study (NLSTEPSS), a prospective population based study. The methodology for ascertainment of cases and data collection has been previously described in detail (AES 2003).. Excluding neonates, children aged less than 16 years with CSE within North London were identified using a multi-tiered notification system. Forward stepwise multivariate logistic regression analysis was used to investigate potential clinical factors associated with admission to PICU. The critical level for entering and removing variables was set at p=0.05 and p=0.1 respectively. 226 children with 304 episodes of CSE were enrolled into the study. 93 children (41%) with 115 episodes of CSE (34%) required admission to PICU. The factors independently associated with admission to PICU were: respiratory depression (OR 24, p[lt]0.00005), CSE duration [gt] 60 mins compared to CSE lasting 30 - 60 minutes (OR 4.3, p[lt]0.00005), onset of CSE in hospital rather than out of hospital (OR 2.7, p= 0.004), incident CSE rather than non-incident CSE (OR 2.5, p= 0.009) and children with previously normal neurological status compared to those with a previous neurological abnormality (OR 2.3, p =0.008). Strategies to decrease the likelihood of respiratory depression associated with CSE and to reduce the likelihood of CSE lasting longer than 60 minutes may lessen the need for admission to PICU and improve outcome.