Increasing Ketamine Use for Refractory Status Epilepticus in US Pediatric Hospitals
Sotirios Keros1,2,3, Ersida Buraniqi4, Byron Alex1,3
11 Weill Cornell Medicine, New York, NY, USA.
Insights
Ketamine is increasingly used for pediatric refractory status epilepticus, often after pentobarbital. This study analyzed its use and outcomes compared to pentobarbital alone, finding increased resource use and mortality with ketamine combination therapy.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Refractory status epilepticus (RSE) in children is a critical neurological emergency.
- Ketamine is an emerging treatment option for RSE, but its clinical application and outcomes are not well-documented.
- Understanding the patterns of ketamine use in pediatric RSE is crucial for optimizing patient care.
Purpose of the Study:
- To describe the utilization patterns and clinical outcomes of ketamine in pediatric refractory status epilepticus.
- To compare outcomes and resource utilization in children treated with ketamine plus pentobarbital versus pentobarbital alone.
- To assess the trend of ketamine use in pediatric RSE over a defined period.
Main Methods:
- Retrospective analysis of the Pediatric Hospital Inpatient System database from 2010 to 2014.
- Inclusion of pediatric patients diagnosed with refractory status epilepticus.
- Comparison of patient characteristics, treatment protocols, in-hospital outcomes, and costs between groups receiving pentobarbital alone and those receiving ketamine in addition to pentobarbital.
Main Results:
- 48 children received ketamine and pentobarbital; 630 received pentobarbital alone.
- The ketamine-pentobarbital group was older, had longer hospital and ICU stays, and experienced higher mortality (29% vs. 17%).
- Median costs were significantly higher in the ketamine-pentobarbital group ($298,000 vs. $148,000). Ketamine use increased over time.
Conclusions:
- Ketamine is increasingly utilized for severe pediatric refractory status epilepticus, typically as an add-on therapy after pentobarbital.
- Combination therapy with ketamine and pentobarbital is associated with increased resource utilization and mortality.
- Further research is warranted to evaluate the efficacy and safety of ketamine in this patient population.
Abstract:
Ketamine is an emerging therapy for pediatric refractory status epilepticus. The circumstances of its use, however, are understudied. The authors described pediatric refractory status epilepticus treated with ketamine from 2010 to 2014 at 45 centers using the Pediatric Hospital Inpatient System database. For comparison, they described children treated with pentobarbital. The authors estimated that 48 children received ketamine and pentobarbital for refractory status epilepticus, and 630 pentobarbital without ketamine. Those receiving only pentobarbital were median age 3 [interquartile range 0-10], and spent 30 [18-52] days in-hospital, including 17 [9-28] intensive care unit (ICU) days; 17% died. Median cost was $148 000 [81 000-241 000]. The pentobarbital-ketamine group was older (7 [2-11]) with longer hospital stays (51 [30-93]) and more ICU days (29 [20-56]); 29% died. Median cost was $298 000 [176 000-607 000]. For 71%, ketamine was given ≥1 day after pentobarbital. Ketamine cases per half-year increased from 2 to 9 ( P < .05). Ketamine is increasingly used for severe pediatric refractory status epilepticus, typically after pentobarbital. Research on its effectiveness is indicated.
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