Abstracts

Patients admitted to NSICU frequently require AEDs for seizure management or prophylaxis. Older AEDs have side effects that decrease their usefulness in ICU. Newer AEDs have overall better side effects and safety profile and are becoming more frequently used in this setting. The goal of this study was to evaluate the patterns of levetiracetam (LEV) use in NSICU. We retrospectively reviewed charts of all patients admitted to NSICU at the University Hospital in Cincinnati between 9/1/03 and 9/30/04. We computed descriptive statistics for the entire sample and conducted bivariate tests (Pearson chi-square tests and t-tests) for differences between groups of patients who received or did not receive LEV. We also computed bivariate correlations (Pearson[apos]s r) between ICU stay and complications of treatment variables. For the analyses involving the complications of treatment variables, we only included cases where the complication was clearly related to the AEDs and not to the primary disease as judged by the clinician treating the patient. 552 charts of patients treated in NSICU were reviewed. 358/379 (94.4%) of NSICU-admitted patients treated with AEDs (ages 16-89) were included in this study. 11 patients were receiving LEV before admission to ICU; therapy with LEV was initiated in 114 patients. A total of 124 patients were treated with LEV in ICU (LEV was discontinued in 1 patient after admission). The 5 most frequent diagnoses were trauma (n=104; 29.1%), SAH (n=102; 28.5%), ICH (n=94; 26.3%), brain tumor (n=73; 20.4%), and SDH (n=66; 18.4%). Many patients carried multiple diagnoses (e.g., trauma/SAH) and are included in both groups. 110 patients (30.7%) carried other diagnoses e.g., status epilepticus, CNS infection, or stroke. LEV was more likely to be initiated in patients already taking phenytoin (p[lt]0.001) and in patients with brain tumors (p=0.064). There was no association between starting LEV and already being treated with carbamazepine or valproic acid (p[gt]0.256). Encephalopathy, acute renal failure, and bleeding complications (anemia, thrombocytopenia, coagulopathy) were associated with a prolonged ICU stay (p[lt]0.047). These complications prompted initiation of LEV more frequently than alternative antiepileptic medications (p[lt]0.025). Patients with liver failure were more likely to receive LEV (p=0.048). This study describes the use patterns of LEV in a large sample of patients with various diagnoses who were admitted to the neuroscience ICU. Older patients and patients with previous complications related either to AEDs or underlying disease were preferentially treated with LEV. LEV appears to be a safe alternative to other AEDs in this setting. Further studies of LEV use in ICU are recommended. (Supported by UCB Pharma.)