To describe trends in acute seizures (seizures occurring < 7 days after the index stroke event) among hospitalized young individuals with spontaneous intracerebral hemorrhage (sICH) and association with mortality.

Acute seizures (AS) are frequent complications of sICH. The rate of intracerebral hemorrhage is rising among young Americans (18 to 60 years). Trends in AS incidence in this age group is largely unknown. Further, the association of AS with mortality has not been reported among young Americans.

The Merative MarketScan® Commercial Claims and Encounters database, for the years 2005 through 2015 served as the data source for this study. Our study population included patients with sICH identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes 430, 431, 432.0, 432.1, and 432.9, excluding those with a prior diagnosis of seizures (ICD-9 codes 345.x and 780.3x). We computed yearly AS incidence and analyzed trends. We applied a logistic regression model to determine the independent association of AS with mortality accounting for demographic and clinical variables.

Of 81,878 sICH patients, 7,611 (9.3%) developed AS. AS incidence increased linearly between 2005 (incidence rate: 8.08%) and 2015 (incidence rate: 10.99%), representing a 26% relative increase; P for trends <0.0001. In-hospital mortality rate was 14.32% among those who developed AS and 11.53% among those who did not. Patients who developed AS were about 30% more likely to die than those who did not (Hazards ratio, HR: 1.315, 95% confidence interval, CI: 1.228-1.408).

Between 2005 and 2015, AS incidence increased by nearly 26% among young Americans with sICH and the occurrence of AS was independently associated with a 30% higher risk of in-hospital death. Future studies will test the benefit of treating AS to reduce mortality after sICH.