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Neurocritical Care

, Volume 19, Issue 1, pp 4–9 | Cite as

Management of Status Epilepticus in Neurological Versus Medical Intensive Care Unit: Does it Matter?

  • Panayiotis N. VarelasEmail author
  • Jesse Corry
  • Mohammed Rehman
  • Tamer Abdelhak
  • Lonni Schultz
  • Marianna Spanaki
  • James Bartscher
Original Article

Abstract

Background

Admission of patients with status epilepticus (SE) to the neurosciences intensive care unit (NICU) may improve management and outcomes compared to general ICUs.

Methods

We reviewed all patients with SE admitted to the NICU versus the Medical ICU in our institution between 2005 and 2008. We included only patients with definite or probable SE based on pre-defined criteria. We collected demographic and clinical data, including severity of admission scores and adjusted short-term outcomes for admission and management in the two ICUs.

Results

There were 168 visits in 151 patients for definite or probable SE, 46 (27 %) of which were in the NICU and 122 (73 %) in the MICU. APACHE II scores were significant higher in the MICU group (17.5 vs 13.4, p = 0.003) and age in the NICU (58.3 vs 51.5 years, p = 0.041). More continuous EEGs were ordered in the NICU (85 vs 30 %, p < 0.001), where fewer patients were intubated, but more eventually tracheostomized. The NICU had a higher rate of complex partial SE and more alert or somnolent patients, whereas the MICU had a higher rate of generalized SE and more stuporous or comatose patients. Admission diagnoses also differed, with the NICU having higher rate of strokes and the MICU higher rate of toxometabolic etiologies (39 vs 12 % and 11 vs 21 %, p = 0.002). After adjustment, no difference was found in mortality, the ICU or hospital length of stay and modified Rankin score at discharge.

Conclusion

SE treatment revealed increased use of continuous EEG in NICU-admitted patients, but without concomitant reduction in LOS or discharge outcomes compared to the MICU.

Keywords

Status epilepticus Neurological intensive care unit Medical intensive care unit Outcomes Continuous electroencephalogram 

Notes

Conflict of interest

No author has any conflict of interest to disclose.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Panayiotis N. Varelas
    • 1
    • 2
    • 4
    Email author
  • Jesse Corry
    • 1
    • 2
  • Mohammed Rehman
    • 1
    • 2
  • Tamer Abdelhak
    • 1
    • 2
  • Lonni Schultz
    • 3
  • Marianna Spanaki
    • 1
  • James Bartscher
    • 1
    • 2
  1. 1.Departments of Neurology Henry Ford Hospital & Henry Ford West Bloomfield HospitalDetroitUSA
  2. 2.Departments of NeurosurgeryHenry Ford HospitalDetroitUSA
  3. 3.Departments of Public Health SciencesHenry Ford HospitalDetroitUSA
  4. 4.Wayne State UniversityDetroitUSA

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