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Background
There is a lack of data concerning socioeconomic outcome and quality of life (QoL) in patients after status epilepticus (SE) in Germany.
Patients and methods
Adult patients treated between 2011 and 2015 due to SE at the university hospitals in Frankfurt, Greifswald, and Marburg were asked to fill out a questionnaire regarding long-term outcome of at least 3 months after discharge. The SE cohort consisted of 25.9% patients with an acute symptomatic, 42% with a remote symptomatic and previous epilepsy, 22.2% with a new-onset remote symptomatic, and 9.9% with other or unknown etiology. A matched case–control analysis was applied for comparison with patients with drug refractory epilepsy and seizure remission, both not previously affected by SE.
Results
A total of 81 patients (mean age: 58.7 ± 18.0 years; 58% female) participated. A non-refractory course was present in 59.3%, while 27.2% had a refractory SE (RSE) and 13.6% had a superrefractory SE (SRSE). Before admission, a favorable modified Rankin Scale (mRS) of 0–3 was found in 82.7% (67/81), deteriorating to 38.3% (31/81) (p = 0.003) at discharge. The majority returned home [51.9% (42/81)], 32.1% entered a rehabilitation facility, while 12.3% were transferred to a nursing home and 3.7% to another hospital. The overall mRS at follow-up did not change; 61.8% (45/74) reached an mRS of 0–3. In RSE and SRSE, the proportion with a favorable mRS increased from 45.5% at discharge to 70% at follow-up, while QoL was comparable to a non-refractory SE course. Matched epilepsy controls in seizure remission were treated with a lower mean number of anticonvulsants (1.3 ± 0.7) compared to controls with drug refractory epilepsy (1.9 ± 0.8; p < 0.001) or SE (1.9 ± 1.1; p < 0.001). A major depression was found in 32.8% of patients with SE and in 36.8% of drug refractory epilepsy, but only in 20.3% of patients in seizure remission. QoL was reduced in all categories (QOLIE-31) in SE patients in comparison with patients in seizure remission, but was comparable to patients with drug refractory epilepsy.
Discussion
Patients after SE show substantial impairments in their QoL and daily life activities. However, in the long term, patients with RSE and SRSE had a relatively favorable outcome comparable to that of patients with a non-refractory SE course. This underlines the need for efficient therapeutic options in SE.
Primary Pan-CT is associated with improved clinical course and outcome in polytrauma patients
(2012)
The early clinical management of patients with polytrauma remains challenging. Clinical examination is unreliable in identifying the presence and severity of injuries, and diagnostic imaging plays a central role in the evaluation of the injury pattern. In the last decade, whole body multi slice computed tomography (Pan-CT) performed immediately after admission gained recognition in Europe and United States. Its utility and value, given the lack of accuracy data and concerns about unnecessary exposure to radiation, is undefined. The primary objective of this retrospective cohort study was to compare survival of multiple trauma (polytrauma) patients (Injury Severity Score [ISS] ≥ 16) prior to (1999 - 2002) and after (2002 - 2004) the introduction of a Pan-CT-based trauma resuscitation algorithm at a maximum care university medical centre. Secondary objectives were to compare the complication rates and duration of intensive care treatment. The study included 123 patients (mean age 34.6 years [SD 16.8], mean ISS 26.7 [SD 8.7]) in the control and 104 (mean age 39.8 years [SD 20.0], mean ISS 28.6 [SD 10.5]) patients in the intervention period. Die Baseline criteria were well balanced amongst both cohorts except for age (34.6 versus 39.8 years, p = 0.034). Both cohorts had a similar predicted probability of survival using the TRISS method (77.5 versus 77.6%, p = 0.979). Raw mortality decreased markedly but not statistically significantly in Pan-CT cohort (17.9 versus 11.5%, risk ratio (RR) 0.65, 95% confidence interval (CI) 0.34 - 1.24). However, after adjustment for injury severity, by mortality odds ratio of 0.40 (95% CI 0.17 – 0.95, p = 0.038) Pan-CT patients were 2.5 times more likely to survive. The mean difference in the duration of ICU treatment (5.1, 95% CI 1.2 – 9.0 days), days on respirator (5.3, 95% CI 2.0 - 8.6), and number of complications (0.4, 95% CI 0.2 – 0.8) was statistically significant and in favour of the Pan-CT-period.
Ausgangspunkt dieser Fall- Kontroll- Studie bildete die Frage, welche Risikofaktoren für das Kurzzeit- und Langzeit-Outcome eines frühgeborenen Kindes bedeutend sind und ob sich diese in den letzten zehn Jahren verändert hat. Hierzu wurden 372 Kinder und ihre Mütter hinsichtlich mütterlicher Erkrankungen, postnatale Anpassung, kindliche Erkrankungen und neurologisches Outcome der Kinder untersucht. Als Risikofaktoren für ein schlechtes neurologisches Follow-up wurden das Gestationsalter, eine AP, mütterliche Infektionen und die kindliche Multimorbidität nachgewiesen. Bei der Mortalität spielten neben dem Geburtsgewicht das Gestationsalter und ein niedriger arterieller Nabelschnur- pH-Wert wichtige Rollen. Weitere mütterliche Erkrankungen zeigten keinen signifikanten Einfluss auf das Outcome der Kinder 2005 zeigten sich bei einer Mortalitätsrate von 9,1% eine erhöhte kindliche Morbidität und ein reduziertes neurologisches Outcome. Im Vergleich dazu konnte 2011 bei geringerer Mortalitätsrate eine Verbesserung des kindlichen Outcomes erreicht und die Morbiditätsrate um 50% reduziert werden. Grund dafür sind moderne Therapiemöglichkeiten und verbesserte zentralisierte perinatale Versorgungsstrukturen, dennoch stellt die Behandlung von Frühgeborenen und die daraus resultierenden Probleme Neonatologen weiterhin vor schwierige Aufgaben.