Status epilepticus (SE) requires informed management. Regional heterogeneity exists in SE epidemiology. We aim to identify regionally-specific outcome predictors by characterizing the SE population of Central New York (CNY).
We scrutinized the SE records available at the single level 4 epilepsy center in CNY between 2018 and 2019. We constructed multivariate and univariate models to assess the association of the dependent (e.g., refractoriness of SE, clinical outcome, and cost of hospitalization) and the independent variables (e.g., anti-seizure medication, anesthetic regimen, and etiology of SE). The models were adjusted for age, sex, and pre-morbid seizure control.
Seventy-seven individuals with definite SE were included. The rate of disability was 20.8% and the all-cause mortality 36.4%. Our analysis showed that initial anti-seizure medication choice - among levetiracetam, valproate, and fosphenytoin - did not have a significant influence on the clinical outcome; nor did it affect the refractoriness of SE. Likewise, the various anesthetic regimen - including midazolam, propofol, pentobarbital, and ketamine - be it alone or in combination, did not alter the course of refractoriness or affect the final outcome. In agreement with previous studies, we recapitulated the phenomenon where age carried a small negative predictive value to the SE-related disability and mortality (CI95% [-0.02, 0], p <0.001). Interestingly, we also found that midazolam (CI95% [-20.81, -0.08], p = 0.048) and the anoxic brain injury (CI95% [-33.50, -1.586], p = 0.03) were marginally associated with shorter hospitalizations, namely the reduced cost. The latter might reflect the rapid course in anoxic brain injury which in our cohort, is evident by higher likelihood of refractoriness (CI95% [0.14, 0.79], p = 0.006).
We described the regional SE demographics, management and prognosis in CNY and further, defined the factors determining the cost-effective care. These findings can be used for regional healthcare and planning optimization.