Continuous Infusion Linked to Worse Outcomes in Pediatric RSE

Continuous infusion results in worse outcomes for patients with pediatric refractory status epilepticus
Continuous infusion results in worse outcomes for patients with pediatric refractory status epilepticus

Treating pediatric refractory status epilepticus (RSE) with continuous infusions may increase the risk of in-hospital mortality and longer stay in the intensive care unit (ICU), according to data presented at the 2017 American Epilepsy Society Annual Meeting, December 1-5, 2017 in Washington, DC.

The multicenter study included 156 patients with status epilepticus whose seizures were not respondent to ≥2 anti-seizure medications (ASM). The investigators created a propensity score based on variables including age, gender, race, tonic-clonic RSE, type of RSE, onset of RSE, etiology, febrile RSE, acute remote etiology, neurological history, delayed first ASM, and previous prescription of rectal diazepam. 

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Of the 156 patients, 78 were treated with continuous infusion and 78 received non-benzodiazepine (BZD) ASM. Propensity score matching for in-hospital mortality resulted in an odds ratio (OR) of 10.6 (95% CI, 1.1-1405.1; P=.037) compared with OR 20.0 and 17.1 for inverse probability of treatment weighting and standardized mortality ratio, respectively.

Patients who underwent continuous infusion had longer ICU stays and were less likely to return to baseline at discharge compared with those who received BZD ASM (median 8.2 days [2.2-20.5] vs 2.3 days [1-4]; P<.001; 81 [67%] vs 86 [86%]; P=.001). After multivariate analysis, continuous infusion remained associated with longer ICU stay (P<.001) but not with return to baseline function (P=.58).

Disclosures: The researchers report support from the Pediatric Epilepsy Research Foundation and Epilepsy Research Fund.

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Reference

Gaínza-Lein M, Chapman K, Sánchez Fernández I, et al. Continuous infusion and outcome in pediatric refractory status epilepticus (the PSERG cohort). Presented at: 2017 American Epilepsy Society Annual Meeting. December 1-5, 2017; Washington, DC. Abstract 2.202.