Emergency response to out-of-hospital status epilepticus A 10-year observational cohort study

Objective: To determine the implications of first responses of emergency medical services (EMS) to out-of-hospital status epilepticus (SE) on outcome. Methods: From 2005 to 2014, prehospital and in-hospital data were assessed in consecutive adults admitted to an academic medical center with out-of-hospital SE. Logistic regression was performed to identify variables with a robust association between missed epileptic events by the EMS and no recovery to functional baseline in survivors. Results: Among 213 SE patients, 150 were admitted via EMS. While nonconvulsive SE (NCSE) was missed by the EMS in 63.7%, convulsive SE (CSE) was not missed except in 4 patients with transformation into subtle SE. Missed NCSE was more likely with older age (odds ratio [OR] per year 1.06, 95% confidence interval [CI] 1.02–1.10, p = 0.003) and no seizure history (OR 6.64, 95% CI 2.43–18.1, p per year 1.05, 95% CI 1.01–1.08, p = 0.008) and higher Glasgow Coma Scale score (OR per increasing unit 1.21, 95% CI 1.09–1.36, p = 0.001). Missed NCSE was independently associated with increased odds for no return to functional baseline in survivors (OR 3.83, 95% CI 1.22–11.98, p = 0.021). Conclusions: Among patients admitted with out-of-hospital SE, CSE is mostly recognized while NCSE is frequently missed especially in patients with increasing age and no seizure history. This calls for heightened awareness for out-of-hospital NCSE in such patients, as missed NCSE is associated with lack of treatment and less recovery to functional baseline in survivors independent of established outcome predictors.