Stroke: Early seizures and other clinical and neuroimaging variables increased the risk of in-hospital mortality.

Clinical bottom line (level 1b)

  1. A sixth of patients who had a first-ever stroke or TIA died in hospital.
  2. Patients were at an increased risk of in-hospital mortality if they had: early seizures, altered consciousness, intraventricular haemorrhage, limb weakness, middle cerebral topography, pathologic conditions, vomiting or advanced age.
Arboix et al: Neurology 1996; 47: 1429-1435
Expires December 2002

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: Neurology department of an acute care hospital, Spain

1099 patients (aged mean 69 years, 52% male) first-ever stroke or transient ischaemic attacks and admitted within 48 hours of symptom onset

Excluded if
  • history of severe head trauma, intracerebral haemorrhage, ischaemic stroke or brain surgery



    • Factors studied:
  • in-hospital mortality
  • early seizures Within 48 hours of cerebrovascular event in a patient with no history of seizures. A simple loss of consciousness or short-lasting episodes of mental confusion were considered not to be an epileptic seizure.
  • altered consciousness
  • intraventricular haemorrhage
  • cranial nerve palsy
  • limb weakness
  • middle cerebral topography
  • pathologic conditions
  • vomiting
  • advancing age




    • A multiple linear regression model was used to adjust for confounding factors.

    followed for time in hospital
    Outcomes studied:
  • in-hospital mortality

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    in-hospital mortality time in hospital 161/1099 14.65%
    (12.56% to 16.74%)

    prognostic factor for
    in-hospital mortality     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    early seizures ? 152/920
    (16.52%)     		6.17
    (2.13 to 17.93)     		3
    (2 to 8)
    altered consciousness ? 48/820
    (5.85%)     		9.53
    (6.16 to 14.7)     		3
    (2 to 5)
    intraventricular haemorrhage ? 129/920
    (14.0%)     		7.55
    (3.33 to 17.1)     		2
    (2 to 5)
    cranial nerve palsy ? 137/884
    (15.5%)     		4.68
    (2.18 to 10.1)     		3
    (2 to 8)
    limb weakness ? 13/289
    (4.50%)     		3.27
    (1.67 to 6.45)     		11
    (5 to 36)
    middle cerebral topography ? 64/538
    (11.9%)     		2.46
    (1.49 to 4.06)     		8
    (4 to 21)
    pathologic conditions ? 82/693
    (11.8%)     		2.06
    (1.31 to 3.23)     		10
    (5 to 32)
    vomiting ? 127/852
    (14.9%)     		1.94
    (1.02 to 3.71)     		10
    (4 to 395)
    advancing age ? 1.04
    (1.03 to 1.07)

    Citation

    1. Arboix A, Comes E, Massons J, et al: Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease. Neurology 1996; 47: 1429-1435
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer: Rowan Harwood

    Clinical Question.
    Patient first stroke or TIA
    Intervention or Exposure early seizure
    Comparison no early seizure
    Outcome mortality