Therapy delay in status epilepticus extends its duration and worsens its prognosis.

Tytuł:: Therapy delay in status epilepticus extends its duration and worsens its prognosis.
Autorzy:: Gutiérrez-Viedma Á; Servicio de Neurología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.; Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain.; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.
Parejo-Carbonell B; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.
Romeral-Jiménez M; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.
Sanz-Graciani I; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.
Serrano-García I; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain.
Cuadrado ML; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.; Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.
García-Morales I; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain.; Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain.
Źródło:: Acta neurologica Scandinavica [Acta Neurol Scand] 2021 Mar; Vol. 143 (3), pp. 281-289. Date of Electronic Publication: 2020 Nov 06.
Typ publikacji:: Journal Article; Observational Study
Język:: English
Imprint Name(s):: Publication: Copenhagen : Wiley-Blackwell
Original Publication: Copenhagen Munksgaard
MeSH Terms:: Time-to-Treatment*
Status Epilepticus/*diagnosis
Status Epilepticus/*therapy
Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Time Factors
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Contributed Indexing:: Keywords: delay; duration; status epilepticus; timing; untimely treatment
Entry Date(s):: Date Created: 20201019 Date Completed: 20210405 Latest Revision: 20210405
Update Code:: 20240105
DOI:: 10.1111/ane.13363
PMID:: 33075155
: Czasopismo naukowe

Pełny tekst

Background: Timing in status epilepticus (SE) attention is probably the most relevant modifiable prognostic factor and may influence SE duration and prognosis. We aimed to describe the precise relationship between management timing, duration, and prognosis of SE.
Methods: Observational longitudinal prospective study on a cohort of all patients diagnosed with SE admitted to our tertiary hospital from September 2017 to August 2019, with a 3-month follow-up. Univariate and multivariable analyses were performed to identify clinical and timing variables associated with SE duration and prognosis.
Results: Eighty-three SE affecting 76 patients were included. Median age was 73 years, 61.4% were women, median baseline modified Rankin Scale (mRS) was 2, and 55.4% had prior epilepsy. In the out-of-hospital group (n = 50), median time to emergencies was 1.3 h and to hospital admission 2.8 h. In the global series, median time to neurologist was 4.3 h, and median time to therapy initiation was 4.5 h. These four times positively correlated with SE duration (all Spearman's rho coefficient >0.5, all p < .001). SE median duration was 24 h and was extended 1.2 h for each hour of treatment delay. A longer SE duration was associated with increased mortality and morbidity, both at hospital discharge and at 3-month follow-up (both p < .05). After 3 months, mortality was 30.1%, while recovery to baseline mRS occurred in 39.5%, with an overall median mRS of 4.
Conclusions: There were pervasive delays in all phases of SE attention, which conditioned a longer SE duration, and this led to increased long-term morbimortality.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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