Hospitalization for status epilepticus is associated with increased morbidity, mortality, and higher costs, and outcomes are worse as the disease becomes refractory, according to study results published in JAMA Neurology.
Previous studies have shown that patients with status epilepticus often require multi-medication treatment in an intensive care unit, with poorer clinical outcomes and higher costs. However, there is limited data on the relationship between disease refractoriness and clinical outcomes and costs.
This cross-sectional study comprised 43,988 hospital admissions for status epilepticus from January 1, 2016 to December 31, 2018. Of these, 14,694 patients (33.4%) had a low refractory rate, which was referred to as treatment with no more than 1 intravenous antiseizure drug, 10,140 (23.1%) had a moderate refractory treatment, which was referred to as treatment with more than 1 intravenous Antiseizur medication was designated, and 19,154 admissions (43.5%) were for highly refractory status epilepticus designated as at least 1 intravenous antiseizure medication, at least 1 third-line intravenous anesthetic, and ICU admission.
The study results included the disposition to discharge, the length of the hospital stay in the intensive care unit, the conditions acquired in the hospital, and the total and daily rate costs.
Since 4,939 died while in hospital, the overall in-hospital mortality rate was 11.2%. The highest in-hospital mortality rate was reported in patients with highly refractory status epilepticus (18.9%), followed by patients with moderate (6.3%) and low (4.6%) refractory status epilepticus (P <0.001 for all comparisons) .
Overall, the median length of stay in the hospital was 5 days, with the length of stay increased for more refractory diseases: 3 days for patients with low, 4 days for patients with moderate and 8 days for patients with highly refractory status epilepticus (P <0.001) for all comparisons ).
The median total hospital cost was $ 13,201, with costs higher for patients with highly refractory epileptic status (median $ 25,105) than for patients with low (median $ 6,812) and moderate (median $ 10,592) refractory epilepticus. Average daily rates were $ 2806.
The study had several limitations, including the lack of long-term outcome data, possible misclassification due to the use of ICD coding and the indication of fire resistance according to the number and type of antiseizure drugs, as well as the exclusion of patients admitted to or from another acute care hospital were relocated.
“Interventions that prevent SE [status epilepticus] Moving to a more refractory state may have the potential to improve outcomes and reduce the costs associated with this neurological disorder, ”concluded the study’s researchers.
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Guterman EL, Betjemann JP, Aimetti A. et al. Relationship between course of treatment, fire resistance and disease burden in hospitalized patients with status epilepticus. JAMA Neurol. Published online April 5, 2021. doi: 10.1001 / jamaneurol.2021.0520