Summary:Purpose: To determine the incidence and casefatality rate of status epilepticus (SE) in adults in Hessen, Germany, we performed a prospective, population-based study from July 1997 through June 1999.Methods: All adult patients residing within the zip-code area 35 (area-35) with SE were included. Area-35 had 743.285 adult inhabitants, including 123.353 adult inhabitants of the primary service area of the University Hospital Marburg (PS-area). Patients were reported by 16 hospitals in the area and were prospectively identified and carefully reviewed within 5 days by one of the authors. Based on the crude annual incidence of SE and a rate of underascertainment of 10% determined for the PS-area, the corrected, age-adjusted incidence of SE in area 35, more representative of the population of Germany, was calculated.Results: The crude annual incidence in the PS-area was 15.8/ 100,000 [95% confidence interval (CI), 11.2-21.6]. The calculated, corrected, age-adjusted incidence of SE in area 35 was 17.1/100,000. It was higher for men compared with women (26.1 vs. 13.7) and for those aged 60 years and older (54.5 vs. 4.2/100,000, p < 0.0001). The etiology was mainly remote symptomatic due to cerebrovascular disease. Epilepsy was previously diagnosed in only 50% of the patients. The case-fatality rate was 9.3%.Conclusions: Based on our data, at least 14,000 patients would be affected by SE in Germany, associated with ∼1,300 deaths annually. The incidence of SE in Germany is similar to that found in the white United States population. Furthermore, this study confirms the higher incidence of SE in male patients and in the elderly population. This may be due to a higher incidence of cerebrovascular disease in these subpopulations.

Summary:Purpose: The aim of this study was to determine the long-term case fatality of patients with a first episode of status epilepticus (SE group) of cerebrovascular etiology, as compared with that in acute stroke patients without SE (AS group).Methods: Patients with SE who had been prospectively admitted to an epidemiologic study were retrospectively compared with a cohort of patients from the local stroke registry. The main outcome end point was overall survival. Survival curves were generated according to the Kaplan-Meier method and compared by using the log-rank test. An extended Cox model was used to examine the impact of patient group on the risk of death. Covariates considered potential confounders included age at diagnosis, sex, type of stroke, affected hemisphere, and localization of lesions.Results: Of 166 patients who entered the study, 93 patients were in the SE group, and 73 patients were in the AS group; 53 SE patients and 35 AS patients died during the study. Patient group (SE vs. AS) showed no significant impact on survival (p = 0.0832) in univariate analysis. In contrast, the results from a multivariable analysis suggest that after 6 months, patients with SE were at about twice the risk of death as were patients with AS [hazard ratio of 2.12 with 95% confidence interval, 1.04-4.32, p = 0.0392].Conclusions: The occurrence of SE in patients with cerebrovascular disease indicates a high risk of death within 3 years. In contrast, the case fatality risk attributable to recurrent status or seizures is lower. Key Words: Long-term mortality-Case fatality-Risk factors-Causes of death-Status epilepticus.Status epilepticus (SE) is a major neurologic emergency with an incidence of ∼20/100,000 for the white population in industrialized countries. Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al., 1994;Towne et al., 1994;Logroscino et al., 1997).SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al., 1995;Logroscino et al., 1997;Lowenstein and Alldredge, 1998;Knake et al., 2001;Rosenow et al., 2002;Wu et al., 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease. and duration of SE were main predictors of increased short-term mortality (Hauser, 1990;Lowenstein and Alldredge, 1998;Wu et al., 2002 In contrast, available reports examining long-term mortality after SE are sparse. Only one recent study systematically analyzed mortality at more than 10 years after the first episode of SE and found an increased long-term mortality of 43%, significantly associated with older age, status duration >24 h, acute symptomatic etiology including stroke, and myoclonic SE caused by hypoxic brain injury (Logroscino et al., 2002).The authors concluded that SE alone...

Introduction: Recent studies indicated an incidence of ALI/ARDS around 17− 64.2 cases per 100.000 person−years and mortality ratios around 30−40%. Objectives: to evaluate the incidence and outcomes of ALI/ARDS in Vitoria city in the southeast of Brazil. Methods: A 15−month prospective observational study (October 2006 to December 2007 was carried out in 14 adults ICU, total of 175 ICU beds. Data was collected daily for 7 consecutive days and on the 14 th and the 28 th day after diagnosis of ALI/ARDS according to the AECC criteria, in patients aged 18−75 years, who required invasive ventilation for more than 24 hours. Period of follow−up was 28 days. Results: From the 7.133 admissions, 130 patients fullfilled ALI/ARDS criteria (1.82%). ALI represented 37.6% and ARDS 62.4% of the patients. The incidence of ALI/ARDS was 7.,57 cases per 100.000 persons− years. Males (62.3%), mean age of 44.24±15.95 years, 32.3% smokers and 26.9% alcoholics. Mean length of ICU stay was 26.48±18.74 days; duration of mechanical ventilation was 21.41±15.41days. The average period till ALI/ARDS diagnosis was 3.83±5.37 days (late ARDS=67.3%). APACHE II for ARDS/LPA (21.31/ 19.69) and LIS (2.39 / 1.86). Risk factors for ALI/ARDS were: pneumonia (35.3%), sepsis (31.5%), broncoaspiration (12.3%), shock (7.7%), lung contusion (6.9%) and multiple trauma (6.9%). The mean FIO2 was 0.68±0.20. Mean tidal volume was 9.36±2.49mL/kg PBW and mean PEEP levels 9.4 ± 3.6cm H2O. Mean plateau pressure was 26.14 ± 7.84cm H2O ( 92% in pressure control ventilation). Overall mortality at 28 days was 31.9% for ALI and 43.2% for ARDS. Conclusions: The incidence of LPA/ARDS in Vitoria was lower than in other regions of the world. Pneumonia and sepsis were the most common risk factors.The 28−day mortality for ARDS was 43.2%. This abstract is funded by: Federal University of Espirito Santo. Am J Respir Crit Care Med 179;2009:A4659 Internet address: www.atsjournals.org Online Abstracts Issue