ArticleThe Neurohospitalist2026
Evaluating Treatment Dynamics in Refractory Status Epilepticus: A Retrospective Observational Cohort Study.
Article in The Neurohospitalist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Background and Purpose: Status epilepticus (SE) is a life-threatening emergency associated with high morbidity and mortality. Limited guidance exists on optimal therapy for refractory SE (RSE), which may include administration of repeat second-line IV-antiseizure medications (IV-ASMs) or escalation to IV-anesthesia (IVA). This study examined real-world treatment dynamics and outcomes of hospitalized patients with RSE in the United States. Methods: A retrospective, cross-sectional analysis of hospitalized patients with SE between 2018-2022 was performed using PINC AI™ Healthcare Database. Patient encounters for RSE were categorized into RSE-no IVA (≥2 IV-ASMs without IVA) and RSE-IVA (≥1 IV-ASMs with IVA and concomitant mechanical ventilation). RSE-no IVA episodes were further stratified by exposure to 2 IV-ASMs and ≥3 IV-ASMs. Results: Across 140 538 SE episodes in 113 229 unique patients, 44% were RSE. IV-ASM and IVA exposure, as well as time to escalation varied widely across SE episodes. Compared to RSE-no IVA episodes (59%), RSE-IVA episodes (41%) were associated with increased ICU length of stay (LOS; 5 vs 3 days), hospital LOS (9 vs 6 days), and in-hospital mortality (25% vs 12%). Compared to patients with RSE-no IVA administered 2 IV-ASMs, those administered ≥3 IV-ASMs had increased ICU admission (73% vs 62%), longer ICU LOS (4 vs 2 days), and hospital LOS (9 vs 5 days). Conclusions: Heterogeneity in RSE treatments management is prominent, with variation in IV-ASM treatment sequencing and escalation timing. Both increased IV-ASM utilization and IVA exposure were associated with similarly worse outcomes and healthcare utilization. Rapidly effective anti-SE treatments remain an urgent unmet need in this patient population.
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