Background: There is limited data on occurrence of generalized convulsive status epilepticus (GCSE) in subarachnoid hemorrhage (SAH) patients at national level.
Objective: We evaluated the occurrence, associated factors, and outcomes after GCSE in patients hospitalized with SAH in the United States.
Methods: We analyzed data from the Nationwide Inpatient Sample (NIS2002-2012). Using the primary ICD-9-CM codes 430 for SAH, patients admitted through the emergency department with a diagnosis of SAH were selected for analysis. Patients with GCSE were identified by using ICD-9-CM code 435.3. Multivariate logistic regression was performed to identify independent predictors of GCSE. The association between GCSE and various outcome measures was also assessed after adjusting for potential confounders.
Results: Out of 286,944 patients hospitalized with SAH, 959 (0.34%) developed GCSE. After adjusting for gender, independent predictors of GCSE in patients hospitalized with SAH included: renal failure [Odd ratio (OR) 2.1 p=0.0084], hydrocephalous [OR 1.9 p<0.0001], sodium abnormalities [OR 1.9 p=0.0001], meningitis [OR 2.3 p=0.0166], sepsis [OR 3.4 p<0.0001], severity score [OR 5.5 p<0.0001] and pneumonia [OR 2.5 p<0.0001]. In multivariate logistic regression model adjusting for age gender and medical comorbidities, patients with GCSE were more likely to be discharged with moderate to severe disability [OR 2.4 , 95% CI 1.5- 3.7]. The in-hospital mortality was higher [OR 1.6, 95%CI 1.1- 2.2] in patients with SAH who developed status epilepticus during the hospitalization.
Conclusions: Patients with SAH who developed GCSE during the hospital admission have higher rates of death and disability. Certain factors helps predicts the occurrence of GCSE in patients with SAH. Early diagnoses, prophylaxis, and treatment may reduce the rates of mortality and disability.