Mortality Rate and Hospitalization Costs Rise with Refractoriness of Status Epilepticus

Status epilepticus (SE) continues to be associated with a large financial and physical burden on patients, with mortality rates and hospitalization costs that increase with disease refractoriness, according to a new analysis published in JAMA Neurology.

Researchers aimed to map how clinical outcomes and hospital costs for SE differ depending on patients’ refractoriness in this cross-sectional study. To do this, they examined 43,988 hospitalizations related to SE in the US between January 1, 2016 and December 31, 2018.

Patients with SE included in the study were categorized by administration of antiseizure drugs during hospitalization. Low refractoriness was defined as treatment with one or less intravenous antiseizure drug, moderate refractoriness was defined as treatment with more than one intravenous antiseizure drug, and high refractoriness was defined as treatment with one or more intravenous antiseizure drug, more than one intravenous anesthetic, and intensive care unit admission.

Among the 43,988 SE related hospitalizations, 33.4% were low refractory, 23.1% were moderate refractory, and 43.5% were highly refractory.

The main outcomes were discharge disposition, hospital length of stay, intensive care unit length of stay, hospital-acquired conditions and cost.

Researchers recorded an overall in-hospital mortality rate of 11.2% and a median hospital length of stay of 5 days. Patients with highly refractory SE had the highest mortality rate at 18.9% and the longest median hospital stay at 8 days compared to patients with moderate and low refractory SE.

Patients with highly refractory SE also saw higher costs than patients with moderate and low refractory SE. The median price for highly refractory SE related hospitalizations was $25,105 compared to $10,592 for patients with moderate refractory SE and $6,812 for patients with low refractory SE.

“Interventions that prevent SE from progressing to a more refractory state may have the potential to improve outcomes and lower costs associated with this neurologic condition,” concluded Elan L Guterman, MD, University of California San Francisco Weill Institute for Neurosciences, and co-investigators. —Erin McGuinness

Source: Guterman EL, Betjemann JP, Aimetti A, et al. Association Between Treatment Progression, Disease Refractoriness, and Burden of Illness Among Hospitalized Patients With Status Epilepticus. JAMA Neurol. Published online April 05, 2021. doi:10.1001/jamaneurol.2021.0520