Characteristics and outcome of patients with the ICU Admission diagnosis of status epilepticus in Australia and New Zealand.

Abstract

Status epilepticus (SE) is a neurological emergency and may lead to Intensive Care Unit (ICU) admission. However, little is known about the characteristics and outcome of patients with the ICU admission diagnosis of SE. We performed a retrospective study of patients admitted to ICU with the primary admission diagnosis of SE as recorded in the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database over more than a decade. We examined the ICU and population incidence, physiological and demographic features of such SE patients; compared ventilated and non-ventilated SE patients and assessed their mortality. From 2000-2013, 12,926 patients (1.2% of all ICU admissions) were admitted to ANZ ICUs with SE as the main admission diagnosis. Over the study period, the ICU prevalence (0.93 vs 1.13%), population incidence (30 vs 61 per million population), ICU length of stay (1.45 vs 1.77 days) and the rate of discharge to a rehabilitation facility (2.3 vs 7.1%) of SE increased (P < .0001). In contrast, the use of mechanical ventilation (56.6 vs 47.2%), hospital length of stay (6.64 vs 5.81 days), ICU (2.6 vs 0.75%) and hospital (8.2 vs 4%) mortality decreased (P < .0001). Overall hospital mortality was 613 (4.7%) with 219 (1.7%) patients dying in ICU. Mortality was associated with advancing age, multiple co-morbidities, lower GCS on admission and higher APACHE III scores. From 2000 to 2013 ICU mortality decreased from 2.6% to 0.75%. Over a 14-year period in ANZ, there have been major changes in the features, management and outcome of patients admitted to ICU with the primary admission diagnosis of SE such that their ICU mortality is now <1%.