Association of hospital location and academic variations with status epilepticus outcomes: A national cohort study
Amelia N Pham1, Alexander Hall2, Ali Al-Salahat1
1Neurology Department, Creighton University, NE, United States.
Background/Introduction:
Outcomes in status epilepticus (SE) depend on rapid seizure control, yet transport times/resources differ by hospital type. We hypothesized that hospital outcomes vary across hospital types: metro-academic (MA), metro-nonacademic (MNA), and non-metro hospitals (NM). Outcomes of interest included in-hospital mortality, length of stay (LOS), 30-/90-day readmission, discharge disposition, and costs, METHODS: Retrospective cohort of adults with SE from the 2016-2022 NRD. Survey-weighted multivariable logistic regression evaluated in-hospital mortality and 30-/90-day readmission. Linear regression evaluated LOS and cost. Models adjusted for age, Charlson Comorbidity Index, ZIP income quartile, and in-hospital severity markers, reporting adjusted OR/coefficients with 95% confidence intervals/ p-values.
Results:
SE hospitalizations occurred predominantly at MA hospitals, whereas NM hospitals disproportionately served patients in the lowest income quartile (64%). MA hospitalizations had higher illness severity, characterized by coma (7.4%), use of mechanical ventilators (<24 h: 15.1%, 24-96 h: 20.8%, >96 h: 10.1%), cardiac arrest (1.6%), sepsis (5.5%), vasopressor infusion (2.3%), and tracheostomy placement (2.1%). MA hospitalizations had greater association with in-hospital complications, including respiratory failure (40.1%), pneumonia (8.1%), acute kidney failure (18.5%), venous thromboembolism (2.1%), pressure ulcers (3.4%), and delirium (2.9%). Mortality (3%) and discharge disposition were similar across hospital types. However, MA hospitalizations had higher 30-/90-day readmissions, longer LOS (t = 12.14, p < 0.0001), and higher costs (t = 13.27, p < 0.0001).
Conclusion:
Despite higher illness severity at MA hospitals, in-hospital mortality and discharge disposition were similar across hospital types. Increased readmissions, LOS, and costs at MA centers likely reflect greater case complexity and may inform resource allocation and interhospital transfer practices.
