Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus 英文参考文献.docVIP

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Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus 英文参考文献.doc

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Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus 英文参考文献

RiskFactorsAssociatedwithDeathinIn-Hospital PediatricConvulsiveStatusEpilepticus TobiasLoddenkemper1.,TanvirU.Syed2.,SriramRamgopal1*,DeepakGulati2, SikawatThanaviratananich2,SanjeevV.Kothare1,AmerAlshekhlee3,MohamadZ.Koubeissi2,4 1DepartmentofNeurology,Children’sHospitalBostonandHarvardMedicalSchool,Boston,Massachusetts,UnitedStatesofAmerica,2DepartmentofNeurology,Case WesternReserveUniversityandUniversityHospitals,Cleveland,Ohio,UnitedStatesofAmerica,3DepartmentofNeurology,StLouisUniversity,St.Louis,Missouri,United StatesofAmerica,4DepartmentofNeurology,GeorgeWashingtonUniversity,Washington,D.C.,UnitedStatesofAmerica Abstract Objective:Toevaluatein-patientmortalityandpredictorsofdeathassociatedwithconvulsivestatusepilepticus(SE)ina large,multi-center,pediatriccohort. PatientsandMethods:WeidentifiedourcohortfromtheKIDInpatientDatabasefortheyears1997,2000,2003and2006. WequeriedthedatabaseforconvulsiveSE,associateddiagnoses,andforinpatientdeath.Univariatelogistictestingwas used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariablelogisticregressionprocedure.P-valueslessthan0.05weretakenassignificant. Results: We identified 12,365 (5,541 female) patients with convulsive SE aged 0–20 years (mean age 6.2 years, standard deviation5.5years,median5years)among14,965,571pediatricinpatients(0.08%).Ofthese,117diedwhileinthehospital (0.9%).ThemostfrequentadditionaladmissionICD-9codediagnosesinadditiontoSEwerecerebralpalsy,pneumonia,and respiratoryfailure.IndependentriskfactorsfordeathinpatientswithSE,assessedbymultivariatecalculation,includednear drowning(Oddsratio[OR]43.2;ConfidenceInterval[CI]4.4–426.8),hemorrhagicshock(OR17.83;CI6.5–49.1),sepsis(OR 10.14;CI4.0–25.6),massiveaspiration(OR9.1;CI1.8–47),mechanicalventilation.96hours(OR9;5.6–14.6),transfusion(OR 8.25;CI4.3–15.8),structuralbrainlesion(OR7.0;CI3.1–16),hypoglycemia(OR5.8;CI1.75–19.2),sepsiswithliverfailure(OR 14.4; CI 5–41.9), and admission i