Abstracts

Rationale: Kern Medical Center (KMC), a community hospital in the California Central Valley, established its critical care monitoring in 2019. Since the establishment of critical care at KMC, there has been no retrospective data analysis of patients who underwent ICU EEG monitoring. In this study we examine the neurological outcome at the time of discharge and at the last time of follow-up for patients admitted to the hospital with status epilepticus (SE) and potential clinical predictors of their prognosis at the time of admission.

Methods: The 2022 ILAE Task Force criteria was used for electroclinical SE classification and further classification into types of SE based on SE duration. [1] The 2021 ACNS Standardized Critical Care EEG Terminology was used for SE EEG classification. The following variables were identified for each patient: GCS on admission, ICU EEG correlates (type of status, semiology), etiology, and Modified Rankin Score at discharge and follow-up to assess functional independence. Patient information was extracted from EHR with the exception of neurological outcome. To obtain current MRS of the patient and ongoing seizure activity, the patient (or next of kin) was contacted. For this study, GCS ≤8 was severe, GCS 9-12 was moderate, and GCS 13-15 was mild. [3] An MRS of 0-2, indicating functional independence to perform ADLs, was considered good. [2] For patients unable to be reached, the most recent follow-up date in EHR was used as the study’s follow-up date to assess MRS if available.

Results: Out of 987 patients who underwent ICU EEG monitoring in the MICU between 2019-2022, a total of 21 SE patients were identified. The ages of determined SE patients were between 26 to 82 years of age. Of the 21, nine patients are deceased, three are alive with MRS 0, three are alive with MRS 5, and six were non-contactable. Patients admitted with admission GCS 0-12 had poor discharge MRS, while GCS 13-15 was not a good predictor of discharge MRS. Among the 13 SE patients with admission GCS 0-12, all but one patient with discharge MRS 0 were either MRS 5 or 6 at follow-up. Meanwhile, of the eight patients with mild GCS, five were discharged with good MRS or good MRS at follow-up. One patient with good GCS at admission expired in the hospital, though the patient’s age (82 years) may have also contributed. Of the other two, both were discharged with MRS 5. One patient was baseline MRS 5 due to an old stroke, and the other patient was unable to be contacted for follow-up. The nine deceased patients had etiologies of meningoencephalitis (2), anoxic ischemic encephalopathy (3), NORSE (1), post-stroke epilepsy (1), toxic/metabolic encephalopathy (1), and acute TBI (1). Twelve of the 21 patients had NCSE. All were refractory SE with the exception of one super-refractory SE and one prolonged super-refractory SE. Seven of the deceased were refractory NCSE, and the other two were refractory myoclonic and focal motor SE.

Conclusions: Useful clinical predictors of poor outcome in SE patients include etiology, GCS on presentation, history of epilepsy, and type of SE.

Funding: N/A