Abstracts

Rationale: Generalized convulsive status epilepticus (GCSE) is associated with significant morbidity and mortality. In one of our studies based on the Nationwide Inpatient Sample, we had concluded that in patients with traumatic brain injury (TBI), GCSE had a three-fold increase in mortality. The objective of this study is to determine if TBI was an independent predictor of mortality, in patients hospitalized with GCSE. Methods: We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged 18 years with GCSE using ICD-9-CM codes 345.3. Patients with TBI were identified using ICD-9-CM codes 800.0-801.9, 803.0-804.9, 850.0-854.1 and 959.01. Secondary independent causes of seizures were excluded. Logistic regression was used to determine if TBI was an independent predictor of mortality in patients with GCSE. Results: From the inpatient-weighted sample, 85249 patient s aged 18 years with GCSE were identified after elimination of other potential causes of seizures and further analysis was done on this cohort. 4339 patients (5%) also had TBI. Among patients with a primary diagnosis of GCSE, those with TBI were younger (Mean age 43.68 vs 49.91), predominantly male (75.4% vs 24.6%) and Caucasians (64.5%), compared to those without TBI. Compared to GCSE patients without TBI, those with TBI had a higher prevalence of alcohol abuse (OR 1.82, 95% CI 1.68-1.97), liver disease (OR 1.47, 95% CI 1.68-1.97), drug abuse (OR 1.47, 95% CI 1.33-1.62), and epilepsy (OR 1.67, 95% CI 1.43-1.95). The prevalence of congestive heart failure (OR 0.35, 95% CI 1.26-1.73), pulmonary disease (OR 0.72, 95% CI 0.64-0.79), diabetes (OR 0.45, 95% CI 0.40-0.51), renal failure (OR 0.25, 95% CI 0.19-0.32), hypertension (OR 0.57, 95% CI 0.53-0.61), deficiency anemia (OR 0.55, 95% CI 0.49-0.62) and coronary artery disease (OR 0.43, 95% CI 0.37-0.50) was lower among patients with TBI. Patients with TBI had lower mean length of stay (4.66 vs 5.30, p=0.00) and lower in house mortality (OR 0.50, 95% CI 0.38-0.67). Using logistic regression we estimated that TBI is not an independent predictor of mortality, in patients hospitalized with GCSE (OR 0.74, 95% CI 0.51-1.08, p=0.115)Conclusions: Among patients with a primary diagnosis of GCSE, those with TBI were predominantly male, had a higher prevalence of alcohol and drug abuse, liver disease and epilepsy; while the prevalence of congestive heart failure, coronary artery disease, hypertension, pulmonary disease, diabetes, renal failure and deficiency anemia were lower. TBI is not an independent predictor of mortality in patients with GCSE.