Abstracts

Rationale: To evaluate in-patient mortality and predictors of death during status epilepticus (SE) in a large, nationwide, pediatric cohort. Methods: We identified our cohort from the KIDS Inpatient Database for the years 1997-2006. We queried the database for SE, and for associated diagnoses as well as death while inpatient. Predictors of death were determined using logistic regression analysis. Results: We identified 12,365 (5541 female) patients with SE among 14,965,571 pediatric inpatients (0.1%); of these 117 died while in the hospital (0.9%). Mean age was 6.2 /-5.5 years (range 0 to 20 years). The sample included 49% Caucasians, 21% Hispanics, 20% African Americans, as well as other ethnicities (9%). Most frequent admission ICD 9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure. None of the socioeconomic factors examined were significant risk factors for death. Independent risk factors for death in patients with SE included near drowning (Odds Ratio (OR) 43.2; Confidence Interval (CI) 4.4-426.8), hemorrhagic shock (OR 17.83; CI 6.5-49.1), sepsis (OR 10.14; CI 4.0-25.6), aspiration (OR 9.1; CI 1.8-47), mechanical ventilation > 96 hours (OR 9; CI 5.6-14.6), transfusion (OR 8.25; CI 4.3-15.8), structural brain lesion (OR 7.0; CI 3.1-16), hypoglycemia (OR 5.8; CI 1.75-19.2), liver failure (OR 14.4; CI 5-41.9), admission in December (OR 3.4; CI 1.6-4.1) and African American ethnicity (OR 0.4; CI 0.2-0.8). Area under the ROC curve for this model is 0.846. Conclusions: Pediatric status epilepticus occurs in up to 0.1% of pediatric inpatient admission, with a mortality of up to 1%. There appear to be several co-morbidities and risk factors that can predict mortality. These may warrant additional monitoring and aggressive management of status epilepticus, and prospective studies to validate these observations.