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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(11): 687-694
DOI: 10.1590/0004-282X20200062
Articles

Predictors of long length of hospital stay among elders admitted with seizures in a tertiary centre: a prospective study

Preditores de longo tempo de internação hospitalar entre idosos admitidos com crises epilépticas em um centro terciário: um estudo prospectivo
Aroldo BACELLAR 
1   Hospital São Rafael, Department of Neurology, D’Or Institute for Research and Education, Salvador BA, Brazil.
,
Telma Rocha de ASSIS 
1   Hospital São Rafael, Department of Neurology, D’Or Institute for Research and Education, Salvador BA, Brazil.
,
Bruno Bacellar PEDREIRA 
1   Hospital São Rafael, Department of Neurology, D’Or Institute for Research and Education, Salvador BA, Brazil.
,
Luan CÔRTES 
2   Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Centre for Health Promotion, Salvador BA, Brazil.
,
Silas SANTANA 
2   Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Centre for Health Promotion, Salvador BA, Brazil.
,
Osvaldo José Moreira do NASCIMENTO 
3   Universidade Federal Fluminense, Department of Neurology, Rio de Janeiro RJ, Brazil.
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ABSTRACT

Population ageing is a global phenomenon, and life expectancy in Brazil is growing fast. Epilepsy is the third most important chronic neurological disorder, and its incidence is higher among elderly patients than in any other segment of the population. The prevalence of epilepsy is greater among inpatients than in the general population and it is related to long length of hospital stay (LOS), which is associated with hospital mortality and higher healthcare costs. Despite these facts, reports of elderly inpatients admitted with seizures and associated outcomes are scarce. Objective: To identify predictors of long LOS among elderly inpatients admitted with seizures. Methods: We prospectively enrolled elders admitted with epileptic seizures or who experienced seizures throughout hospitalization between November 2015 and August 2019. We analysed demographic data, neurological disorders, clinical comorbidities, and seizure features to identify risk factors. Results: The median LOS was 11 days, with an interquartile range (IQR) of 5-21 days. The frequency of long LOS (defined as a period of hospitalization ≥12 days) was 47%. Multivariate analysis showed there was an exponential increase in long LOS if a patient showed any of the following conditions: intensive care unit (ICU) admission (OR=4.562), urinary tract infection (OR=3.402), movement disorder (OR=5.656), early seizure recurrence (OR=2.090), and sepsis (OR=4.014). Conclusion: Long LOS was common among elderly patients admitted with seizures, and most predictors of long LOS found in this cohort might be avoidable; these findings should be confirmed with further research.

RESUMO

O envelhecimento populacional é um fenômeno global e o crescimento da expectativa de vida no Brasil tem sido rápido. A epilepsia é a terceira doença neurológica crônica mais importante e sua incidência em idosos é maior do que em qualquer outro segmento populacional. A prevalência de epilepsia é maior entre pacientes internados e está relacionada a longo tempo de internação (TDI), o qual está associado a custos elevados e mortalidade hospitalar. Apesar disso, são escassos os relatos de desfechos de pacientes idosos internados com crises epilépticas e resultados associados. Objetivo: Identificar fatores de risco de longo TDI em idosos admitidos com crises epilépticas. Métodos: Recrutamos prospectivamente pacientes idosos admitidos com crises epilépticas ou que tiveram crises durante a internação hospitalar entre novembro de 2015 e agosto de 2019. Analisamos dados demográficos, distúrbios neurológicos, comorbidades clínicas e tipos de crise epiléptica para identificar fatores de risco. Resultados: A mediana do TDI foi 11 dias, com intervalo interquartil (IIQ) de 5-21 dias. A frequência de longo TDI (definido como TDI≥12 dias) foi 47%. A análise multivariada mostrou que houve um aumento exponencial de TDI quando o paciente apresentou algumas dessas condições: admissão em unidade de terapia intensiva (UTI) (OR=4,562), infecção urinária (OR=3,402), transtorno do movimento (OR=4,562), recorrência precoce de crise epiléptica (OR=2,090) e sepse (OR=4,014). Conclusão: Longo TDI é um desfecho desfavorável importante e foi comum entre idosos admitidos com crises epilépticas. Muitos dos preditores de longo TDI encontrados nessa coorte podem ser evitados, o que deve ser confirmado com pesquisas futuras.

Keywords:

Epilepsy - Seizure - Aged - Length of Stay - Risk Factors

Palavras-chave:

Epilepsia - Convulsões - Idoso - Tempo de Internação - Fatores de Risco

Authors’ contributions:

AB conceived the study idea, designed the methods, collected data, performed statistical analysis, and drafted the manuscript; TA, BBP, LC, and SS collected data, examined medical records, and reviewed manuscript drafts; LC also performed the English editing; OJN discussed the study idea, methods, statistical analysis, and results. All authors read, discussed, and approved the final manuscript.


Data availability:

The data used to support the findings of this study are available from the corresponding author upon request.




Publication History

Received: 17 April 2020

Accepted: 27 May 2020

Article published online:
07 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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