Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study

Introduction: Limited information is available about the impact of seizures on stroke outcome, health care delivery and resource utilization. Objective: To determine whether the presence of seizures after stroke increases disability, mortality and health care utilization (length of hospital stay, ICU admission, consults, discharge to a long-term care facility). Methods: This cohort study included consecutive patients with acute stroke between July 2003 and June 2005 from the Registry of the Canadian Stroke Network (RCSN), the largest clinical database of patients in Canada with acute stroke seen at selected acute care hospitals. We compared clinical characteristics and outcomes amongst patients experiencing stroke without and with seizures occurring during inpatient stay. Main outcome measures included: case-fatality, disability at discharge, length-of-stay, and discharge disposition. A logistic regression analysis was used to determine whether the presence of seizures was associated with poor stroke outcomes. Results: Amongst 5027 patients included in the study; seizures occurred in 138 (2.7%) patients with stroke. Patients with seizures had a higher mortality at 30-day (36.2% vs. 16.8%, P < 0.0001) and at 1-year post-stroke (48.6% vs. 27.7%, P < 0.001), longer hospitalization, and greater disability at discharge (P < 0.001). Multivariate analysis revealed that stroke severity, hemorrhagic stroke, and presence of neglect were associated to occurrence of seizures after stroke. Conclusions: The presence of seizures after stroke was associated with increased resources utilization, length of hospital stay, whilst decreasing both 30-day and 1-year survival. Quality improvement strategies targeting patients with seizures may help optimize the management of this subgroup of more disabled patients.