Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany.
Epilepsia. 2019 May;60(5):911-920. doi: 10.1111/epi.14729. Epub 2019 Apr 13.
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.
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.
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.
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.
癫痫持续状态（SE）是一种重要的医学急症，在难治性和超难治性 SE（SRSE）中尤其预后不良。儿科人群中 SE 尤其是 SRSE 的经济负担尚不清楚。本研究旨在确定儿科患者 SE 的疾病负担。
利用国际疾病分类和相关健康问题第十次修订版（ICD-10）的 SE（G41）、癫痫（G40）或热性惊厥（R56）编码，从全国性保险研究数据库中选择 2008 年至 2015 年期间 0-18 岁因癫痫发作入院的患者保险记录。患者进一步根据入住重症监护病房和使用机械通气进行分类。
该算法共识别出 11693 例与癫痫发作相关的入院病例，其中 4%的病例被归类为 SE。在这些病例中，282 例（60.4%）被算法归类为非难治性 SE（NRSE），125 例（26.8%）为难治性 SE（RSE），60 例（12.8%）为 SRSE。未经调整的 SE 发病率为 17.6/100000，NRSE 为 11.4/100000，RSE 为 3.9/100000，SRSE 为 2.3/100000。SRSE 发病率在 0-1 岁年龄组中最高，占所有儿科 SRSE 入院患者的 48.3%。所有 SE 病例的中位住院时间（LOS）为 7 天，SRSE 为 44.5 天，NRSE 为 5 天，RSE 为 12 天。SE 总住院费用为 15880 欧元，SRSE 为 75358 欧元，NRSE 为 4119 欧元，RSE 为 13864 欧元。非 SE 癫痫入院的平均 LOS 为 3 天，癫痫的平均费用为 2697 欧元，热性惊厥的平均费用为 1614 欧元。非 SE 和 NRSE 入院病例无死亡，而 SE 的总体死亡率为 3%，RSE 为 5.6%，SRSE 为 11.7%。
尽管被归类为 SE 的病例仅占癫痫发作相关入院病例的 4%，但它们占总费用的 22%。这些费用主要由 SRSE 病例构成，占所有 SE 相关费用的 62%。
