RESUMO
OBJECTIVE: To provide data on inpatient costs and cost-driving factors in children and adolescents due to non-refractory (NSE), refractory (RSE), and super-refractory status epilepticus (SRSE). METHODS: All children and adolescents treated for status epilepticus (SE) between 2011 and 2018 at the Frankfurt University Hospital were analyzed for health care utilization. RESULTS: We evaluated 223 admissions in 174 patients (6.8 ± 5.1 years, median 5.5 years, range 0.1-17.5 years, 109 males [62.6%]) treated for SE. Mean costs of hospital treatment were 5,711 (median 2,330, range = 654-102,414) per patient per admission, with a mean length of stay (LOS) of 9.2 days (median 5.0, range = 1-101), resulting in mean costs of 621 per SE treatment day. Course of SE had a significant impact on the mean costs, which were 3,386 in NSE (median 2,139, range 654-38,236, 529 per treatment day; 37% of total inpatient costs due to SE), 7,409 in RSE (median 2,772, range 700-38,236; 612 per treatment day, 38% of total inpatient costs due to SE) and 17,436 in SRSE (median 6,911, range 2,138-102,414; 842 per treatment day, 25% of total inpatient costs due to SE). Independent cost-driving factors were three or more treatment steps, acute-symptomatic etiology, and unfavorable modified Rankin Scale score at admission. Increased LOS was predicted by three or more treatment steps and unfavorable modified Rankin Scale score at admission. Overall mortality at discharge was 1.3% (three patients). CONCLUSIONS: Acute treatment of SE, and particularly RSE and SRSE, is associated with high hospital costs and prolonged LOS. Patients with disabilities are at risk for an unfavorable course of SE, resulting in prolonged LOS. In general, mortality associated with SE is low in children and adolescents, however three or more treatment steps are associated with high treatment costs.
