Abstract Details

Title Patient Journey in Status Epilepticus: Understanding Treatment Pathways, Outcomes, and Health Care Burden Using Patient Level Hospital Data

Topic Neuro Trauma and Critical Care

Presentation(s) P4 - Poster Session 4 (11:45 AM-12:45 PM)

Poster/Presentation
Number 2-002

Objective We aimed to characterize the various treatment pathways and clinical outcomes in patients across the status epilepticus (SE) continuum.

Background SE is a common, life-threatening neurological emergency. Uncontrolled SE despite 1^st and 2^nd line therapy is considered refractory SE (RSE) and may require additional intravenous antiseizure medications (IV ASMs) or escalation to IV anesthesia (IVA).

Design/Methods

Hospital-based, service-level, all-payer US data from the PINC AI™ Healthcare Database (2018-2022) and Komodo Health Healthcare Map (2017-2022) were analyzed. Hospitalizations with an SE ICD-10 CM code at the admit, primary, or secondary diagnostic position were included. Episodes were categorized as: SE (benzodiazepine only); established SE (ESE; 1 benzodiazepine and 1 IV ASM); RSE (≥2 IV ASMs without IVA [RSE-noIVA] or ≥1 IV ASM with IVA and concomitant mechanical ventilation [MV, RSE-IVA]). Super-refractory SE (SRSE) described RSE-IVA and ≥2 days of MV.

Results This cross-sectional study examined 140,538 SE episodes in 113,229 unique patients over 5 years. SE was the admit, primary, or secondary diagnosis in 35%, 55% and 41% of episodes, respectively. Most episodes were categorized as SE (36%), ESE (19%), and RSE (45%). In patients with RSE, 41% received IVA and 11% progressed to SRSE. RSE-IVA patients had increased ICU and hospital length of stay (LOS) and in-hospital mortality vs RSE-noIVA or ESE cohorts. Even without IVA (RSE-noIVA), patients who received ≥3 IV ASMs had increased ICU admission, and longer ICU and hospital LOS than those responsive to 2 IV ASMs. One-third of episodes required inter-hospital transfers which were more common in RSE-IVA. Recurrent SE was observed in 20% of patients.

Conclusions Patients with SE have complex care pathways requiring specialized care and multi-institutional interactions. Treatment refractoriness and IVA exposure in SE is associated with increased ICU and hospital LOS and worse outcomes. Rapidly effective anti-SE treatments remain an urgent unmet need in this patient population.

Authors/Disclosures
Megan Barra (Brigham and Women'S Hospital) PRESENTER	Ms. Barra has received personal compensation for serving as an employee of Marinus Pharmaceuticals.
Sri Saikumar (Trinity Life Sciences)	No disclosure on file
Saloni Shah	No disclosure on file
Dushyant Katariya (Trinity Life Sciences)	No disclosure on file
Adrienne Lovink (Trinity Life Sciences)	No disclosure on file
Henrikas Vaitkevicius, MD (Marinus Pharmaceuticals)	Dr. Vaitkevicius has received personal compensation for serving as an employee of Noema Pharmaceuticals. Dr. Vaitkevicius has stock in Noema Pharmaceuticals.
Eva Rybak, PharmD (Marinus)	Dr. Rybak has received personal compensation for serving as an employee of Marinus Pharmaceuticals . Dr. Rybak has received stock or an ownership interest from Marinus Pharmaceuticals .

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