Rationale:
Status epilepticus (SE) is an acute, life-threatening condition characterized by continuous or recurrent seizures. SE is associated with significant morbidity and economic cost but the extent of these burdens and association with SE severity is poorly characterized. This study aimed to describe clinical and cost outcomes associated with SE hospitalizations in the United States (US) in the context of SE severity.
Method:
Data from the Premier Healthcare Database (which contains approximately 25% of US inpatient hospital admissions) from 2016 to 2018 was examined. Patients with SE were identified by ICD-10 diagnosis codes and stratified into 3 cohorts, using number and type of antiepileptic drug (AED) as a proxy for SE severity. Cohort 1 received <1 intravenous (IV) AED and no IV anesthetic (low severity). Cohort 2 received >1 IV AED and no IV anesthetic (moderate severity). Cohort 3 received >1 IV AED, >1 IV anesthetic, and was admitted to the ICU (high severity). Clinical outcomes were discharge disposition, hospital-acquired complications, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Economic outcomes were total and per diem hospital cost.
Results:
There were 43,988 SE hospitalizations to 736 unique hospitals. Of these,14,694 (33.4%) hospitalizations were low severity, 10,140 (23.1%) were moderate severity, and 19,154 (43.5%) were high severity. In-hospital mortality across all cohorts was 11.2% and overall mean hospital LOS was 8.4 days (bootstrap 95% CI 8.3, 8.6). Mortality rates were highest in patients with high severity SE (cohort 3; 18.9%) as compared to those with moderate (cohort 2; 6.3%) and low severity SE (cohorts 1; 4.6%) (p< 0.001). Hospitalizations for high severity SE also had significantly longer mean hospital LOS (12.0 days) and ICU LOS (6.6 days) as compared to hospitalizations for moderate (hospital LOS 7.2 days; ICU LOS 3.1 days; p< 0.001 for both) and low severity SE (hospital LOS 4.7 days; ICU LOS 2.7 days; p< 0.001 for both) (Table). Cohort 1 had the lowest rates of catheter-associated urinary tract infections, vascular catheter-associated infections, and pressure ulcers (p< 0.001 for all comparisons to more severe SE cohorts). Median [mean (bootstrap 95% CI)] hospital costs per admission increased with higher SE severity. Hospitalization costs for cohorts 1, 2, and 3 were $6,812 [$11,532($11,269, $11,826)], $10,592 [$18,328 ($17,750, $18,983)], and $25,105 [$41,858 ($$41,017, $42,701)], respectively, resulting in per diem costs of $2,366 [$2,862 ($2,823,$2,905)], $2,460 [$2825 ($2,785,$2,866)], and $3,359 [$3,868 ($3,381, $3,904)] (p< 0.001 for all pairwise comparisons).
Conclusion:
Patients with SE have high clinical severity and associated hospital costs. Using antiepileptic treatment as a proxy for SE severity, we demonstrated that mortality, LOS, and hospital cost were markedly higher among patients with more severe SE, demonstrating the need to optimize care and develop more effective therapies aimed at reducing SE severity.
Funding:
:Marinus Pharmaceuticals
FIGURES
Figure 1