The in-hospital mortality and potential predictors of outcome of generalized convulsive status epilepticus (GCSE) were evaluated at the Neurological Institute, Case School of Medicine, Cleveland, OH. The cohort was identified from the Nationwide Inpatient Sample (NIS) databases for the years 2000 through 2004. The definition of status epilepticus employed was continuous seizures or repetitive seizures without recovery of consciousness of 30 or more minutes' duration. The analysis included 11,580 patients (mean age 39 +/- 25.6 years, 53.4% male, 42.4% white) with a median hospital stay of 3 days. Mortality was 3.45% overall. Adjusted mortality rates by age were 0.67% for patients < or =10 years, 1.33% for ages 11-20, increasing to 10.15% for patients >80 years. Potential predictors of death identified female sex, mild Charlson Comorbidity Index (chronic illness without cancer), and Northeast hospital location. Mortality tripled in those requiring mechanical ventilation (7.43% vs 2.22%;p<0.0001), mostly older patients. Potential etiologies and complications of GCSE that predicted mortality included cerebrovascular disease, hypoxic-ischemic brain injury, cardiac disease, respiratory failure, and higher comorbidity index. In the first decade of life, GCSE is the most common neurologic emergency. The number of cases <10 years old in this cohort (2,524, 21.8%) was comparable to all cases older than 60 years of age (2,627, 22.7%). [1]

COMMENT. A bimodal age distribution of cases of GCSE, with highest frequencies in children <10 years and in the elderly is similar to other reports. The low mortality rate in young children in this study, lower than some previous series, is explained by the authors as a reflection of improved management and availability of rectal antiepileptic medications, or the relatively low frequency of acute symptomatic epilepsies in their cohort. A more detailed analysis of etiological factors related to GCSE outcome in children would be of interest, especially in children <1-2 years of age, when the incidence is highest and febrile CSE is the most common cause.