| Backgrounds and objectives: Status epilepticus(SE)is a common neurological issue with substantial mortality and morbidity.The goal of this study was to shine a light on the SE prognosis and to reduce the occurrence of sequelae and improve patients’ quality of life.Methods: A retrospective review was performed for 298 cases of children(not including newborns)who admitted to the Affiliated Hospital of Soochow University between January 2013 and June 2017.The outcomes were measured by Glasgow Outcome Score(GOS).GOS=5 was defined as a good outcome,and GOS<5 as a bad outcome.The prognostic factors were analyzed,as well as the factors of PICU.In addition,the long-term follow-up for children with febrile convulsion was also included in this study.Results: 1.Two hundred and ninety-eight children with SE were enrolled,163(54.70%)girls and 135(45.30%)boys.There were 154 cases(51.68%)with a history of seizure,of which 98 cases(63.63%)were epileptic.There were 143 new onset SE without a history of seizure,and 17 cases(13.60%)were diagnosed with epilepsy when they were discharged.SE occurred in 191 cases(7-21 points)during the activity time,accounting for 64.09%.292 cases were CSE,accounting for 97.99% and 6 cases(2.01%)NCSE.Most of them were febrile seizure(92 cases,30.87%),followed by remote symptomatic(81 cases,29.19%).There were 32 cases(10.74%)of the self-resolvers after the SE attack,and 100 patients(33.56%)with a single sedative control,and 96 cases(32.21%)with two sedatives.Using Glasgow outcome score scale(GOS)describe the prognosis,254 cases of children with GOS = 5(85.23%),11 cases(3.69%)children = 4 points,24 cases(8.05%)children = 3 points,9 cases(3.03%)= 2 points,no in-hospital deaths.2.Prognostic factors were explored in this study:(a)Single factor analysis: we found that PICU,need breathing machine auxiliary breath,has a history of convulsions,developmental delay,new onset SE,with febrile,long time convulsions,comprehensive attack,require various sedative treatment,there are abnormal electroencephalogram(EEG)and cranial images,symptoms of acute disease because these are all the adverse factors affecting the prognosis.(b)Multivariate analysis: PICU(OR=4.306,95%CI :1.554~11.933;P=0.005),developmental delay(OR=3.054,95%CI : 1.157~8.066;P=0.024),abnormal head image(OR=2.657,95%CI: 0.914~7.731;P=0.073)due to recent poor prognosis.3.Recent prognostic factors of PICU monitoring group.The hospitalization time of PICU,developmental delay,the atypical attack type,electroencephalogram and neuroimaging abnormality,and the etiology of these five factors were correlated with the prognosis of PICU group,among which PICU was hospitalized(OR=36.912,95%CI: 5.165~263.787;P<0.001)and developmental delay(OR=14.403,95%CI: 1.725~120.273;P=0.014)was an independent risk factor for poor outcome of PICU monitoring group.4.Not timely settle into the treatment group PICU rate(P = 0.395,OR = 0.395,95% confidence interval,0.444 to 1.378),the incidence of RSE(P = 0.929,OR = 0.929,95% confidence interval,0.547 to 1.734),the incidence of poor outcome(P = 0.875,OR = 0.875,95% confidence interval,0.467 to 1.915).For the timely settle,there was no statistically significant difference between the treatment groups.Conclusions: There is no obvious gender difference in children SE,which can occur at all ages,and 1 ~ 3 years old is the peak.The onset type was mainly CSE(97.99%),and NCSE was rare(2.01%).The most common diseases of SE was febrile seizure(30.87%),13.60% of epilepsy with SE as the starting performance,other acute symptoms(14.09%),mainly for encephalitis(57.14%),gastroenteritis(23.81%)with seizures.1.The duration of SE attack was related to the etiology,and the febrile seizure was 85.87% within 1 hour.A small amount of SE(10.74%)can be alleviated by itself,and 65.77% of SE can be relieved by 1 ~ 2 kinds of treatment drugs.There was no significant difference in the incidence of PICU monitoring,RSE incidence and prognosis.2.The following risk factors highly related to Children SE: age,into the PICU,endotracheal intubation,backward history of convulsions,growth and development,new onset SE,fever,comprehensiveness,refractory SE,EEG and cranial imaging abnormalities,the cause.Among them,PICU monitoring,developmental backwardness and abnormal head image were the independent risk factors of poor prognosis.Comprehensive attack,febrile seizure because of the prognosis of non-risk factors.3.The patients received PICU monitoring were related to the poor prognosis of SE: PICU stay time,non-comprehensive attack,EEG and cranial image abnormality,developmental lag,and etiology.The duration and development of PICU were the early warning factors of poor prognosis in PICU monitoring cases. |
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