Therapeutic coma for status epilepticus: Differing practices in a prospective multicenter study.

Détails

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Etat: Public
Version: Final published version
ID Serval
serval:BIB_97DB83788FC1
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Therapeutic coma for status epilepticus: Differing practices in a prospective multicenter study.
Périodique
Neurology
Auteur(s)
Alvarez V., Lee J.W., Westover M.B., Drislane F.W., Novy J., Faouzi M., Marchi N.A., Dworetzky B.A., Rossetti A.O.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Statut éditorial
Publié
Date de publication
18/10/2016
Peer-reviewed
Oui
Volume
87
Numéro
16
Pages
1650-1659
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
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.
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.
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).
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.
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.

Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Coma/chemically induced, Comorbidity, Drug Resistant Epilepsy/complications, Drug Resistant Epilepsy/mortality, Drug Resistant Epilepsy/therapy, Female, Humans, Length of Stay, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Status Epilepticus/complications, Status Epilepticus/mortality, Status Epilepticus/therapy, Switzerland, Tertiary Care Centers, Treatment Outcome, United States, Young Adult
Pubmed
Création de la notice
25/10/2016 14:47
Dernière modification de la notice
20/08/2019 15:59
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