Abstracts

This study examines Status Epilepticus (SE) in terms of location at onset, location of care, location cases are admitted from and discharged to, services providing care and mortality.
Data was obtained from the NIH Greater Richmond Metropolitan Area Status Epilepticus data system; prospectively collected data on SE cases in Richmond, Virginia. Patient location at SE onset was broken into 3 groups; SE that began outside of the hospital (Outside), in transit to the hospital (Transit) and while the patient was already in the hospital (Hospital). The various hospital services were explored, including the service the patient was on when SE started and the service the patient was admitted or transferred to for care. The type of environment where the cases were admitted from and discharged to was also examined, and included home (Home), and other facilities or units such as rehabilitation, nursing homes and adult homes (Other). Mortality by location was also examined.
A total of 270 cases were available for this analysis. Males accounted for 51.5%, females 48.5%. Race distribution was 66% African-American, 32% Caucasian, and 2% Other. Overall mortality was 19%; 15% in African Americans and 29% in Caucasians, with no significant difference in mortality by gender. Most cases (57%) began SE Outside, with 2% starting SE in Transit and 41% starting SE in the Hospital. Mortality was much higher (40%) in the Hospital group than in the Outside (5%) and Transit (0%) groups. At SE onset, the majority of SE cases (66%) received care in the Emergency Department, with 8% on the Neurology service, 8% on a Medicine service, 7% on the Neurosurgery service, 4% on a Surgery service and 3% on Pediatrics, with the remainder of cases on other services such as OB/GYN and Psychiatry. Services where SE cases were admitted or transferred to for care were Neurology (54%), Pediatrics (20%), Medicine (12%), Neurosurgery (7%), and Surgery (3%). When SE cases were not on the Neurology service, they often were seen by Neurology in consultation, however 5% of the cases were never seen by Neurology. SE cases were admitted from home 86% of the time and these cases had a 17% mortality versus a 31% mortality seen in the Other group. Of the SE survivors, 63% were discharged to Home and 37% to Other environments.
Location at SE onset appears to be an important factor in outcome, with higher mortality seen in Hospital cases and in cases admitted from environments other than home. The majority of SE cases received initial care in the Emergency Department, and the majority of patients were admitted or transferred to the Neurology service. This initial study shows that 46% of SE cases were on non-Neurology services for care, that most of these cases were seen by Neurology in consultation, however 5% were never seen by Neurology. Further study is indicated to elucidate other factors affecting outcome as well as to optimize treatment of SE.
[Supported by: NIH P01 NS25630]