Early-hospital readmission after generalized status epilepticus during stroke hospitalization

Objective: To assess the relationship between generalized convulsive status epilepticus (GCSE) during an index stroke hospitalization and occurrence of 30-day hospital readmission.

Methods: Retrospective analysis of data within the 2014 National Readmission Database, a national dataset tracking readmissions in the United States. We identified patients with an index discharge diagnosis of stroke using the International Classification of Disease, Ninth Revision, Clinical Modification (433.X1, 434.X1, and 436 for ischemic stroke and 430, 431, 432.0, 432.1, and 432.9 for hemorrhagic stroke) and a subset of patients with GCSE (345.3). We explored the association between GCSE and 30-day readmission using multivariable logistic regression, while applying recommended survey weights.

Results: Of 271,148 adults with a primary diagnosis of stroke hospitalizations in the US in 2014, 591 (0.21%) had GCSE. The prevalence of GCSE was 0.14% among ischemic stroke patients and 0.64% among hemorrhagic stroke patients. Readmission rates were 11.9% for all strokes, 11.6% for ischemic strokes, and 14.2% for hemorrhagic strokes. Readmission rates were significantly higher for those with GCSE vs. without GCSE regardless of stroke type. Adjusted odds ratios for the association of GCSE with 30-day readmission were 1.30 (95% CI: 1.02-1.65) for all strokes, 1.19 (95% CI: 0.84-1.71) for ischemic strokes, and 1.39 (95% CI: 0.92-2.10 0.09) for hemorrhagic stroke.

Conclusion: Approximately one in eight hospitalized stroke patients who experience in-hospital GCSE are re-admitted to a hospital within 30 days with a nominally higher rate of readmissions among those with hemorrhagic stroke.