The burden of decisional uncertainty in the treatment of status epilepticus

Abstract

Objective: Treatments for convulsive status epilepticus (SE) have a wide range of effectiveness. The estimated effectiveness of non-intravenous benzodiazepines (non-IV BZDs) ranges from approximately 70% to 90% and the estimated effectiveness of non-benzodiazepine antiseizure medications (non-BZD ASMs) ranges from approximately 50% to 80%. This study aimed to quantify the clinical and economic burden of decisional uncertainty in the treatment of SE. Methods: We performed a decision analysis that evaluates how decisional uncertainty on treatment choices for SE impacts hospital admissions, intensive care unit (ICU) admissions, and costs in the United States. We evaluated treatment effectiveness based on the available literature. Results: Use of a non-IV BZD with high estimated effectiveness, like intranasal midazolam, rather than one with low estimated effectiveness, like rectal diazepam, would result in a median (p 25-p 75

Descriptive epidemiology and health resource utilization for status epilepticus in the emergency department in the United States of America

“…The increasing availability of testing and aggressive management might lead clinicians to test for an etiology more in primary SE, while that is not needed in secondary SE. Therefore, an early and effective treatment of seizures that prevents their evolution into SE and make visiting the ED unnecessary may greatly reduce the downstream clinical and economic impacts on the patient and the healthcare system [51]. Secondary SE cases probably had higher underlying severity when presenting to the ED than primary SE as shown by higher risk of admission, length of stay if admitted, and mortality.…”