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Abstract
Objective: Our aim was to analyze and compare the use of therapeutic coma (TC) for refractory status epilepticus (SE) across different centers and its effect on outcome.
Methods: Clinical data for all consecutive adults (>16 years) with SE of all etiologies (except postanoxic) admitted to 4 tertiary care centers belonging to Harvard Affiliated Hospitals (HAH) and the Centre Hospitalier Universitaire Vaudois (CHUV) were prospectively collected and analyzed for TC details, mortality, and duration of hospitalization.
Results: Two hundred thirty-six SE episodes in the CHUV and 126 in the HAH were identified. Both groups were homogeneous in demographics, comorbidities, SE characteristics, and Status Epilepticus Severity Score (STESS); TC was used in 25.4% of cases in HAH vs 9.75% in CHUV. After adjustment, TC use was associated with younger age, lower Charlson Comorbidity Index, increasing SE severity, refractory SE, and center (odds ratio 11.3 for HAH vs CHUV, 95% confidence interval 2.47–51.7). Mortality was associated with increasing Charlson Comorbidity Index and STESS, etiology, and refractory SE. Length of stay correlated with STESS, etiology, refractory SE, and use of TC (incidence rate ratio 1.6, 95% confidence interval 1.22–2.11).
Conclusions: Use of TC for SE treatment seems markedly different between centers from the United States and Europe, and did not affect mortality considering the whole cohort. However, TC may increase length of hospital stay and related costs.
Classification of evidence: This study provides Class III evidence that for patients with SE, TC does not significantly affect mortality. The study lacked the precision to exclude an important effect of TC on mortality.
GLOSSARY
- ASD=
- antiseizure drug;
- BZD=
- benzodiazepine;
- CCI=
- Charlson Comorbidity Index;
- CHUV=
- Centre Hospitalier Universitaire Vaudois;
- CIVAD=
- continuous IV anesthetic drug;
- HAH=
- Harvard Affiliated Hospitals;
- ICU=
- intensive care unit;
- LOS=
- length of stay;
- NCSEC=
- nonconvulsive status epilepticus in coma;
- ROC=
- receiver operating characteristic;
- SE=
- status epilepticus;
- STESS=
- Status Epilepticus Severity Score;
- TC=
- therapeutic coma
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
Editorial, page 1636
- Received December 7, 2015.
- Accepted in final form May 20, 2016.
- © 2016 American Academy of Neurology
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- RE: Comment regarding therapeutic coma for Status Epilepticus
- Therapeutic coma for status epilepticus
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