Objective:

To determine if direct admission of status epilepticus (SE) patients to a comprehensive epilepsy center (CEC) is associated with improved outcome compared to admission to a community hospital with subsequent CEC transfer. 

Background:

Immediate transfer to a specialized center is beneficial in acute stroke patients but it is not clear if that conveys any benefit to patients with other neurologic emergencies. We sought to compare the outcome of patients with SE directly admitted to a CSE with those undergoing transfer from community hospitals. 

Design/Methods:

All patients admitted to a neurosciences ICU with SE were included in this observational study. A standardized data collection form was used to collect demographics, length of stay, mortality, in-hospital complications, discharge disposition, need for tracheostomy or percutaneous gastrostomy, and medications needed to terminate SE. Categorical variables were compared with Fisher’s exact test and continuous variables with t-test. 

Results:

110 patients were evaluated during a 2-year period; median age was 63 and 50% were males. Direct admission to the CEC occurred in 57(52%)-secondary transfer in 53(48%) patients. There was no difference in median age, race, or gender between groups. Similarly, there was no difference in the incidence of pneumonia, urinary infection, venous thromboembolism,  kidney failure, tracheostomy/gastrostomy need, or death between groups ( P> 0.05 for all). Direct CES admission was associated with statistically significant decreased length of stay (17.64 days vs. 24. 08, p = 0.001) and with increased odds of home/acute rehabilitation at discharge (27/57 vs.14/53 p= 0.03 ).  Transferred patients were more likely to need 2 or more anesthetic agents to abort SE ( 0.042).

Conclusions:

In this study SE patients admitted directly to a CES had significantly shorter length of stay, were more likely to be discharged to acute rehabilitation or home and required less anesthetic agents.