Skip to main content

Incidence, risk factors, and impact on hospital mortality of status epilepticus after subdural hemorrhage in the United States

Introduction

Patients with intracranial hemorrhages are at risk of seizure activity. Small cohort studies have shown that patients with subdural hemorrhages (SDH) may be at risk of developing status epilepticus (SE). In this study, we sought to determine the epidemiology of SE, the prevalence of risk factors, and the impact on hospital mortality in SDH, using a large administrative dataset.

Methods

Data were derived from the National Inpatient Sample from 1988 through 2008. We searched for admissions with a primary diagnosis of SDH, and SE. Definitions were based on the International Classification of Diseases, 9th Revision. Adjusted incidence rates, prevalence odds ratios (ORs), and 95% confidence intervals (CIs) were calculated.

Results

Over the 20-year period, we identified 890,153 admissions with primary diagnosis of SDH and 3,214 of SE. The population-adjusted rate of SDH increased from 9/100,000/year in 1988 to 22/100,000/year in 2008, and similarly, the adjusted rate of SE in SDH increased from 0.05/100,000/year in 1988 to 0.11/100,000/year in 2008. In SDH patients, the risk of SE was higher in older than younger patients (OR, 0.99; 95% CI, 0.99 to 1.0, P = 0.06), black than whites (OR, 1.5; 95% CI, 1.2 to 1.9), and in the presence of respiratory failure (OR, 4.3; 95% CI, 3.5 to 5.3), metabolic dysfunction (OR, 1.7; 95% CI 1.3 to 2.26), hematologic disorders (OR, 1.7; 95% CI, 1.3 to 2.26), renal failure (OR, 2.4; 95% CI, 2.1 to 3.26), or central nervous system dysfunction (OR, 2.6; 95% CI, 2.1 to 3.26). The total in-hospital mortality fell from 17% in 1988 to 11% in 2008, yet the number of deaths increased over the study period. In-hospital mortality was higher among SE (OR, 1.6; 95% CI, 1.3 to 2.0) older patients (OR, 1.01; 95% CI, 1.01 to 1.01), women (OR, 1.1; 95% CI, 1.01 to 1.1); and in those with respiratory organ dysfunction (OR, 4.9; 95% CI, 4.7 to 5.2), cardiovascular dysfunction (OR. 2.9; 95% CI, 2.7 to 3.2), hematologic dysfunction (OR, 2.2; 95% CI, 2.1 to 2.3), metabolic dysfunction (OR, 2.5; 95% CI, 2.2 to 2.8), renal dysfunction (OR, 2.0; 95% CI, 1.9 to 2.1).

Conclusions

Our study demonstrates that the incidence of SDH and SE in these patients is increasing in the United States. The risk of SE was higher among older patients, blacks, and in those with respiratory, metabolic, hematological, and renal system dysfunction. Despite a decline in overall SDH-related mortality, SE increased the risk of in-hospital death.

References

  1. 1.

    Rubin G, et al.: Epilepsy in chronic subdural hematoma. Acta Neurochir 1993, 123: 39-42.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A Seifi.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Seifi, A., Urtecho, J., Maltenfort, M. et al. Incidence, risk factors, and impact on hospital mortality of status epilepticus after subdural hemorrhage in the United States. Crit Care 15, P330 (2011). https://doi.org/10.1186/cc9750

Download citation

Keywords

  • Respiratory Failure
  • Status Epilepticus
  • Hospital Mortality
  • Primary Diagnosis
  • Metabolic Dysfunction