Burden of illness for super-refractory status epilepticus patients

Beg, Jamil M; Anderson, Thomas D.; Francis, Kevin; Meckley, Lisa M.; Fitzhenry, David; Foster, Todd; Sukhtankar, Susheel; Kanes, Stephen; Moura, Lidia M.V.R.

doi:10.1080/13696998.2016.1223680

Cited by 28 publications

(49 citation statements)

References 50 publications

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“…A recent retrospective study from the United States on a pediatric SRSE patient population is in line with our results with an average LOS for children aged 0‐18 of 20 days and an average ICU stay of 12 days . Mean hospital cost amounted to USD 73 230 .…”

Section: Discussionsupporting

confidence: 89%

“…The observed database incidence rate of 17.6 cases per 100 000 patients is generally in alignment with numerous previous reports in various pediatric populations . The most recent comprehensive studies showed pediatric SE incidences of 13‐23 per 100 000 children .…”

Section: Discussionsupporting

confidence: 88%

“…The most recent comprehensive studies showed pediatric SE incidences of 13‐23 per 100 000 children . Notably, increased SE incidence in the vulnerable infant (<2 years of age) population has been shown in many studies over the past decades; however, this study is the first to further stratify patients and show that this spike in SE is associated with an increase in SRSE incidence and mortality in the newborn population. The stratification of SE into NRSE, RSE, and SRSE also facilitated the examination of hospital resource utilization.…”

Section: Discussionmentioning

confidence: 71%

“…SRSE is associated with significant morbidity and fatality. Generally, in adults, about 25% of patients with SRSE return to baseline, about 35% recover with neurologic deficits, and 40% die . A wide range of SE incidence rates have been reported, with an upper limit of 61/100 000 in adults, and the mortality rate increases with increasing severity of SE, with rates of 19%‐40% reported in SRSE .…”

Section: Introductionmentioning

confidence: 99%

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Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

et al. 2019

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Summary Objective Status epilepticus (SE) is an important medical emergency condition with particularly unfavorable outcome in refractory and superrefractory SE (SRSE). The economic impact of SE and especially of SRSE in the pediatric population remains unclear. We aimed to determine the burden of illness of SE in a pediatric patient population. Methods Insurance records for patients aged 0‐18 years admitted between 2008 and 2015 were selected from a nationwide insurance research database utilizing International Classification of Diseases and Related Health Problems, 10th Revision (ICD‐10) codes for SE (G41), epilepsy (G40), or febrile convulsions (R56). Patients were further classified based on admission to the intensive care unit and use of mechanical ventilation. Results The algorithm identified 11 693 seizure‐related admissions and classified 4% as SE. Of these cases, 282 (60.4%) were classified by the algorithm as nonrefractory SE (NRSE), 125 (26.8%) as refractory SE (RSE), and 60 (12.8%) as SRSE. The crude SE incidence was 17.6/100 000, with NRSE being 11.4/100 000, RSE 3.9/100 000, and SRSE 2.3/100 000. SRSE incidence peaked in the 0‐ to 1‐year‐old age subgroup accounting for 48.3% of all pediatric SRSE admissions. The median length of stay (LOS) for all SE cases was 7 days, with median 44.5 days in SRSE, 5 days in NRSE, and 12 days in RSE. Mean admission costs for total SE were €15 880, with a mean expense for SRSE of €75 358, for NRSE of €4119, and for RSE of €13 864. The mean LOS for non‐SE epilepsy admissions was 3 days, with mean costs of €2697 for epilepsy and €1614 for febrile convulsion admissions. There were no deaths in non‐SE and NRSE admissions, whereas the overall mortality for SE was 3%, with 5.6% in RSE and 11.7% in SRSE. Significance Although cases classified as SE represented 4% of the seizure‐associated admissions, they accounted for 22% of the overall costs. These costs were disproportionately represented by SRSE cases, which accounted for 62% of all SE‐associated costs.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

et al. 2019

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“…SE is refractory to adequate first‐ and second‐line treatment with benzodiazepines (BZDs) and nonsedating antiseizure drugs (ASDs) in 31%‐44% of cases . Refractory status epilepticus (RSE) is associated with higher morbidity and mortality than SE that responds to initial treatment, contributing to increased health care costs . Because RSE becomes more refractory to treatment over time, current management guidelines, based on expert opinion, suggest that the duration of an artificially induced (therapeutic) coma (TC) should last between 24 and 48 hours .…”

Section: Introductionmentioning

confidence: 99%

Duration of therapeutic coma and outcome of refractory status epilepticus

et al. 2019

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Summary Objective: Examine the association of duration of therapeutic coma (TC) with seizure recurrence, morbidity, and mortality in refractory status epilepticus (RSE). Define an optimal window for TC that provides sustained seizure control and minimizes complications. Methods: Retrospective, observational cohort study involving patients who presented with RSE to the University of Alabama at Birmingham or the University of California at San Francisco from 2010 to 2016. Relationship of duration of TC with primary and secondary outcomes was evaluated using two-sample t tests, simple linear regression, and chi-square tests. Multivariable linear and logistic regression models were used to identify independent predictors. Predictive ability of TC for seizure recurrence was quantified using a receiver-operating characteristic curve. Youden index was used to determine an optimal cutoff value. Results: Multivariable analysis of clinical and treatment characteristics of 182 patients who were treated predominantly with propofol as anesthetic agent showed that longer duration of the first trial of TC (27.2 vs 15.6 hours) was independently associated with a higher chance of seizure recurrence following the first weaning attempt (P = 0.038) but not with poor functional neurologic outcome upon discharge, in-hospital complications, or mortality. Furthermore, higher doses of anesthetic utilized during the first trial of TC were independently associated with fewer in-hospital complications (P = 0.003) and associated with a shorter duration of mechanical ventilation and total length of stay. Duration of TC was identified as an independent predictor of seizure recurrence with an optimal cutoff point at 35 hours. Significance: This study suggests that a shorter duration yet deeper TC as treatment for RSE may be more effective and safer than the currently recommended TC duration of 24–48 hours. Prospective and randomized trials should be conducted to validate these assertions.

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Association Between Treatment Progression, Disease Refractoriness, and Burden of Illness Among Hospitalized Patients With Status Epilepticus

et al. 2021

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IMPORTANCE Status epilepticus (SE) is associated with poor clinical outcomes and high cost. Increased levels of refractory SE require treatment with additional medications and carry increased morbidity and mortality, but the associations between SE refractoriness, clinical outcomes, and cost remain poorly characterized.OBJECTIVE To examine differences in clinical outcomes and costs associated with hospitalization for SE of varying refractoriness. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study of 43 988 US hospitalizations from January 1, 2016 to December 31, 2018, was conducted, including patients with primary or secondary International Statistical Classification of Diseases, Tenth Revision, diagnosis specifying "with status epilepticus." EXPOSURE Patients were categorized by administration of antiseizure drugs given during hospitalization. Low refractoriness denoted treatment with none or 1 intravenous antiseizure drug. Moderate refractoriness denoted treatment with more than 1 intravenous antiseizure drug. High refractoriness denoted treatment with 1 or more intravenous antiseizure drug, more than 1 intravenous anesthetic, and intensive care unit admission. MAIN OUTCOMES AND MEASURESOutcomes included discharge disposition, hospital length of stay, intensive care unit length of stay, hospital-acquired conditions, and cost (total and per diem). RESULTS Among 43 988 hospitalizations for SE, 22 851 patients (51.9%) were male; mean age was 49.9 years (95% CI, 49.7-50.1 years). There were 14 694 admissions (33.4%) for low refractory, 10 140 (23.1%) for moderate refractory, and 19 154 (43.5%) for highly refractory SE. In-hospital mortality was 11.2% overall, with the highest rates among patients with highly (18.9%) compared with moderate (6.3%) and low (4.6%) refractory SE (P < .001 for all comparisons). Median hospital length of stay was 5 days (interquartile range [IQR], 2-10 days) with greater length of stay in highly (8 days; IQR, 4-15 days) compared with moderate (4 days; IQR, 2-8 days) and low (3 days; IQR, 2-5 days) refractory SE (P < .001 for all comparisons).

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Burden of illness for super-refractory status epilepticus patients

Abstract: SRSE is associated with high mortality and morbidity, which place a high burden on healthcare resources. Projections based upon the findings of this study suggest an estimated 25,821-41,959 cases of SRSE may occur in the US each year, but more in-depth studies are required.

Cited by 28 publications

References 50 publications

Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

Duration of therapeutic coma and outcome of refractory status epilepticus

Association Between Treatment Progression, Disease Refractoriness, and Burden of Illness Among Hospitalized Patients With Status Epilepticus

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