Abstracts

Rationale: Status Epilepticus (SE) is a neurologic emergency seen commonly at tertiary care centers. There are up to 200,000 cases of SE diagnosed each year in the United States. Figures from the mid-1990s suggested that SE accounted for approximately $4 billion annually. Over the last decade, treatment of patients in SE has changed, most notably from the use of newer antiepileptic drugs (AEDs). The objective of this study is to evaluate the cost of treating SE and potential predictors of poor financial reimbursement relative to cost of treatment. Methods: A retrospective review of the Mayo Clinic Arizona EEG database from January 1, 2002 to December 31, 2007 was completed. All EEG records that demonstrated electrographic SE were identified and the electronic medical record was reviewed for each correlating hospital admission. Data abstracted included age at presentation, length of stay, medications used for treatment and thirty day mortality. Additionally, a cost-reimbursement ratio (CRR) was calculated for each admission by dividing the total cost billed for each admission (dependent upon individual patients’ insurance) by the total reimbursement (including patient contribution) for the same admission. Using a CRR, factors such as fluctuations in reimbursement rates over time and differing hospital charges between institutions and insurance companies are minimized. A CRR greater than one suggests cost exceeds reimbursement (i.e. loss). Results: Forty-three unique patient admissions were identified. The patients ranged from 12 to 84 years-old (average 56), as Mayo Clinic Hospital does not routinely care for pediatric patients. Twenty (47%) of these patients were 60 years-old or greater and average length of stay was 11.8 days (range 1-59 days). Twenty-one (49%) of these patients were admitted or transferred with SE, while the remainder were admitted for other reasons and developed SE during the hospital admission. As defined by needing greater than two AEDs to electrographically improve the SE pattern, 26 (60%) were refractory cases. Overall thirty day mortality was 42%. Average CRR from all patients was 0.90 (range 0.41 to 10.24). Table 1 displays the percentage of patients in various demographic groups who had a CRR greater than one. This data demonstrates that older age, refractory SE, and death within 30 days of discharge suggest that the admission costs will likely to exceed reimbursement. Conclusions: Despite the more widespread use of newer AEDs, overall demographics and outcomes for SE have not changed. The seemingly high refractory SE rate and mortality rate in this series likely represent a selection bias based on multiple factors. A majority of these patients had multiple medical comorbidities and nine (21%) of these patients were transferred for management of prolonged SE. Additionally, technical factors would imply that SE would be present at least 30 minutes prior to be able to document SE electrographically. With declining hospital reimbursements, financial analyses will further emphasize why SE management must be treated early and aggressively.