Abstracts

Rationale: Generalized convulsive status epilepticus (GCSE) is associated with significant morbidity and mortality. The incidence of GCSE in traumatic brain injury (TBI) patients, its risk factors, and its influence on mortality are unknown. The objective of this study is to determine the incidence, predictors and outcomes of GCSE in hospitalized patients with TBI. Methods: We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged 18 years with TBI using ICD-9-CM codes 800.0-801.9, 803.0-804.9, 850.0-854.1 and 959.01. Patients with GCSE were identified using ICD-9-CM code 345.3. Secondary causes that could independently cause seizures were excluded. Logistic regression was used to determine independent predictors of GCSE in patients with TBI. Results: From the inpatient weighted sample, 14,81,444 patient s aged 18 years with TBI were identified; of which 12,46,536 patients with TBI had no other potential causes of seizures and further analysis was done on this cohort. 1,475 (0.001%) patients had GCSE (mean age 61.5 years, 62.6% men, 64% white). Compared to TBI patients without GCSE, those with GCSE were older, African-American, had a higher prevalence of medical co-morbidities, and were more likely to undergo invasive procedures such as craniotomy, craniectomy, ventriculostomy, intracranial pressure monitoring, hematoma drainage, intubation and mechanical ventilation, tracheostomy and percutaneous endoscopic gastrostomy placement. Using logistic regression, African-American race (OR 2.28, 95% CI 1.90-2.72), coagulopathy (OR 2.39, 95% CI 1.96-2.91), diabetes with chronic complications (OR 2.23, 95% CI 1.62-3.06), drug abuse (OR 2.03, 95% CI 1.60-2.56), deficiency anemia (OR 2.02, 95% CI 1.78-2.38), congestive heart failure (OR 1.70, 95% CI 1.40-2.07), alcohol abuse (OR 1.55, 95% CI 1.31-1.84), and chronic kidney disease (OR 1.29, 95% CI 1.02-1.61) were identified as independent predictors of GCSE in TBI patients. Female gender (OR 0.84, 95% CI 0.73-0.96), coronary artery disease (OR 0.77, 95% CI 0.64-0.93) and epilepsy (OR 0.47, 95% CI 0.28-0.78) were inversely associated with GCSE. Those with GCSE also had significantly higher in-hospital mortality (8.7% vs. 27.3%; unadjusted OR 3.96, 95% CI 3.53-4.44; adjusted OR 3.76, 95% CI 3.26-4.34) and longer average length of stay (5.9 9.7 vs. 14.9 21.2 days, p<0.001). Conclusions: Although GCSE is a relatively uncommon complication among patients with TBI, it is associated with three times higher in-hospital mortality and prolonged hospitalization. African-American race, coagulopathy, diabetes with chronic complications, drug abuse, deficiency anemia, congestive heart failure, alcohol abuse and chronic kidney disease are important predictors of GCSE in patients with TBI.