Abstracts

Rationale: The aim of this study was to collect retrospective epidemiological data on cost, and length of stay from status epilepticus (SE) encounters and based on demographics. This data has potential to be reviewed for evaluation of current performance measures after implementing an educational quality improvement project in 2020 meant to improve the algorithm currently used for treatment of SE.


Methods: This study was a retrospective medical record review in the electronic medical record in University Hospital Truman Medical Center (UHTMC). Prior to the study, educational conferences involving the Emergency department physicians and residents were completed on 4/23/2020 for 45-60 minutes.



The medical record used at University Hospital Truman Medical Center (UHTMC) from 2018-2021 was used. Patients were assessed using the diagnosis codes for SE through the diagnosis codes used for various Status epilepticus codes via IT request and the billing department.



Only the patients who were recorded to have either 2 generalized tonic clonic seizures < 5 minutes apart without return to baseline or one generalized tonic clonic seizure lasting >5 minutes were included regardless if they had the ICD codes indicating SE. Information that was pulled from the EMR included patient age, gender, race, charges, total direct cost excusing revenue offsets, total indirect cost, total cost excluding revenue offsets, primary payor, check in date and time, discharge date and time, discharge date and time, length of stay, mechanical ventilation, EMT arrival time, time of first seizure, inpatient SE date and time, time to first benzodiazepine, which benzodiazepines were given and dose, triage time, time of first ASM, which ASM was given and dose, if the protocol was followed, etiology of the visit, risk factors, type of seizures, home ASM, ASM levles, UDS and alcohol use, CT or MRI at time of visit or prior, encounter EEG, prior history of seizures, disposition, intubation, and sequela.




Results: Based on our inclusion criteria, which was further confirmed on medical record review, there were 119 cases of status epilepticus in 3 successive academic years.

Descriptive statistics showed 48.7% female. Majority of the patients were black or african american (57.1%), and had government insurance (69.8%). The mean cost of taking care of a status epilepticus case (unadjusted to inflation) was approximately $21.080 ($1747-$133869).

A Mann-WHitney U test was run to assess the cost difference since starting protocol and with implementation of a more aggressive approach to this neurological emergency.There was no difference in the mean cost associated with each episode of status epilepticus following our intervention. U=1619, z=0.797, p >0.05. Henceforth, the cost remained steady.


Conclusions: Despite protocol changes, and implementation of an aggressive treatment via protocol and algorithm updates in our hospital, the cost to take care of each status epilepticus event did not change. Further analysis is ongoing on how the protocol change may have affected the duration of the hospital stay, and also the time to treat each SE event following our intervention.


Funding: NA