Logroscino et al reported risk factors for short-term mortality in a patient with a first episode of status epilepticus. This can help to identify a patient who may require more aggressive management. The authors are from Columbia University, Ospedale Miulli Acquaviva Bari, Mayo Clinic and University of Texas at Houston.
Patient selection: first episode of status epilepticus
Outcome: 30-day mortality
Parameters:
(1) gender
(2) age in years
(3) seizure type
(4) duration in hours
Parameter
Finding
Hazard Ratio, adjusted
gender
male
1
female
0.4
age
< 1 year
5.2
1 to 19 years
1
19 to 65 years
7.6
> 65 years
18.4
seizure type
generalized
1
secondarily generalized
2.3
partial
0.8
duration
< 2 hours
1
2 to 24 hours
0.9
> 24 hours
1.3
cumulative hazard ratio =
= PRODUCT(hazard ratios for the 4 parameters)
Interpretation:
• minimum cumulative hazard ratio: 0.29
• maximum cumulative hazard ratio: 55
• The risk of mortality was greatest in the elderly and in patients with an acute provoking factor.
Acute provoking factors include:
(1) CNS infection
(2) cerebrovascular disease
(3) brain trauma
(4) acute diffuse encephalopathy (anoxic, other)
(5) alcohol
(6) drug discontinuation
(7) other toxic-metabolic insult
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