Status Epilepticus-Related Hospitalizations Rise as Mortality Stabilizes

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There appears to be a disconnect between stable rates of status epilepticus-related mortality and an increase in status epilepticus hospitalizations, according to a study published in JAMA Neurology. The disconnect is likely due to an increase in diagnoses and changes in billing and coding.

John P. Betjemann, MD, of the University of California – San Francisco, and colleagues performed 2 retrospective cross-sectional studies of 408,304 status epilepticus-related hospital visits from January 1, 1999 to December 31, 2010. Centers for Disease Control and Prevention death certificate data, using International Statistical Classification of Diseases, Tenth Revision, codes were used to determine both nonstandardized and age-standardized rates of status epilepticus as cause of death, and data from the Nationwide Inpatient Sample were used to estimate population-standardized status epilepticus-related hospitalization rates using International Statistical Classification of Diseases, Ninth Revision, codes.

Status epilepticus was the reported underlying cause of death in 613 deaths in 2010. Age-standardized status epilepticus-related mortality per 1,000,000 persons increased by 5.6% (incident rate ratio, 1.004; 95% CI, 1.002-1.006) from 1.79 in 1999 to 1.89 in 2010. Population-standardized hospitalizations for status epilepticus per 100,000 persons increased by 56.4% (incident rate ratio, 1.013; 95% CI, 1.012-1.013) from 8.86 in 1999 to 13.86 in 2010. Patients who were intubated with nonprincipal diagnoses of status epilepticus recorded the largest increase (181.6%; incident rate ratio, 1.030; 95% CI, 1.029-1.030) and among insurance providers, Medicare patients saw an 81.3% increase. The diagnoses were classified by whether status epilepticus was the principal diagnosis, whether the patient was intubated, and by primary insurance type.

The disconnect observed between stable mortality rates and increasing hospitalization rates likely reflect an improvement in diagnostic sensitivity, the researchers concluded.

Emergency
Status Epilepticus-Related Hospitalizations Rise as Mortality Stabilizes

Status epilepticus is a common neurologic emergency with significant associated morbidity, mortality, and health care costs, yet limited data exist detailing trends in status epilepticus–related hospitalizations and mortality.

We performed 2 retrospective serial cross-sectional studies including 408 304 status epilepticus–related hospital visits using generalizable national data from January 1, 1999, to December 31, 2010, from the Centers for Disease Control and Prevention and the Nationwide Inpatient Sample. Centers for Disease Control and Prevention death certificate data, using International Statistical Classification of Diseases, Tenth Revision, codes, were used to determine nonstandardized and age-standardized rates of status epilepticus as the underlying cause of death in the United States. 

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