(taken from abstract) Status epilepticus (SE) is a common, life- threatening medical emergency that is experienced by about 150,000 people in the United States (US) each year, with up to 40,000 SE-associated deaths. In spite of treatments that are often effective, systematic emergency diagnostic and therapeutic protocols for SE are lacking in most hospitals. Unless diagnostic and therapeutic interventions are specifically directed to subpopulations of patients who will benefit most, it is unlikely that significant improvements in the care of patients with SE will be achieved rapidly. Data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP-3) have been recently used to describe the general characteristics of inpatients in the US with SE, and to demonstrate that SE increases the odds of all-cause mortality among inpatients in the US after controlling for co-morbid conditions and other potential confounding variables. Stroke, closed head injury, bacterial meningitis, and viral encephalitis are among the most common significant co-morbidities among hospitalized patients with SE. The long-term goals of our research are to: (a) Characterize the sub- populations of hospitalized patients in the US at highest risk for developing SE, and identify those inpatients who experience a significant increase in the odds of death associated with SE; (b) Propose a systematic intervention strategy for SE diagnosis and treatment for these sub-populations that minimizes medical errors, enhances rapid Diagnosis, and improves clinical outcomes; and (c) Study the effectiveness of the new proposed SE diagnostic and therapeutic delivery system among hospitalized patients. During this one-year grant period, we will extend our initial analyses of SE using the NIS HCUP-3, 1988-1997, to achieve the following Specific Aims: (1) Using the NIS data we will determine the frequency, the trends in frequency, and the geographic variations of SE among hospitalized patients in the US with bacterial meningitis, viral encephalitis, closed head injury, and/or stroke; (2) Using the NIS data, we will determine the impact of SE on the odds of death, controlling for potential confounding variables, among inpatients in the US with bacterial meningitis, viral encephalitis, closed head injury, and/or stroke; (3) Using the NIS data, we will conduct four separate analyses to determine the factors that increase the odds of developing SE among inpatients with bacterial meningitis, viral encephalitis, closed head injuries, and/or stroke.
