Objectives: To study the clinical profile and predictors of outcome in children with status epilepticus (SE) during resuscitation in pediatric emergency department.
Materials and methods: This retrospective study was carried out in a tertiary care teaching hospital. Admission and resuscitation data of children, aged between 1 month and 12 years, treated for SE, between September 2013 and August 2014, were extracted using a standard data collection form. Our SE management protocol had employed a modified pediatric assessment triangle to recognize and treat acute respiratory failure, cardiovascular dysfunction (CD), and subtle SE until all parameters resolved. Continuous positive airway pressure, fluid boluses based on shock etiology, inotropes, and cardiac safe anticonvulsants were the other modifications. Risk factors predicting mortality during resuscitation were analyzed using univariate and penalized logistic regression.
Results: Among 610 who were enrolled, 582 (95.4%) survived and 28 (4.6%) succumbed. Grunt odds ratio (OR): 3.747 (95% confidence interval [CI]: 1.035-13.560), retractions OR: 2.429 (95% CI: 1.036-5.698), rales OR: 10.145 (95% CI: 4.027-25.560), prolonged capillary refill time OR: 3.352 (95% CI: 1.339-8.388), and shock requiring >60 mL/kg fluids OR: 2.439 (95% CI 1.040-5.721) were associated with 2-3 times rise in mortality. Inappropriate prehospital treatment and CD were the significant predictors of mortality OR: 7.82 (95% CI 2.10-29.06) and 738.71 (95% CI: 97.11-999), respectively. Resolution of CD was associated with improved survival OR: 0.02 (95% CI: 0.003-0.17).
Conclusion: Appropriate prehospital management and treatment protocol targeting resolution of CD during resuscitation could reduce mortality in children with SE.
Keywords: Cardiovascular dysfunction; Pediatric assessment triangle; prehospital care; status epilepticus.