Incidence, mortality, and management of status epilepticus from 2012 to 2022: An 11-year nationwide study.

Abstract

Objective: Recent data on status epilepticus (SE) incidence and mortality remain limited, despite the 2015 revision of its definition by the International League Against Epilepsy. The impact of the COVID-19 pandemic also remains unclear. We assessed trends in SE incidence, mortality, and management from 2012 to 2022 and examined the pandemic's impact.

Methods: We conducted a retrospective cohort study using the French National Health Data System, including all patients with a first hospitalization coded for SE (International Statistical Classification of Diseases, 10th Revision) from 2012 to 2022. Patients were stratified by intensive care unit (ICU) admission and mechanical ventilation (MV) duration. Annual age-standardized incidence rates were analyzed using Poisson regression. ICU admission rates, in-hospital mortality, and 1-year mortality were compared to 2019 (reference), adjusting for demographics, causes, and comorbidities. Interrupted time series analysis assessed changes during the pandemic.

Results: We identified 118 050 patients hospitalized for first SE. From 2012 to 2019, the incidence of SE hospitalization decreased annually by 1.9%, from 18.0 to 15.6 per 100 000 (incidence rate ratio [IRR] = .981, 95% confidence interval [CI] = .978-.984). ICU hospitalizations declined similarly (from 10.4 to 9.59 per 100 000, IRR = .989, 95% CI = .986-.993), except among patients without MV. In-hospital mortality was 22.9% and 1-year mortality was 36.0% in 2019, stable compared to 2012. The highest mortality occurred in patients requiring prolonged MV or not admitted to ICU. During the COVID-19 years (2020-2022), SE hospitalizations dropped significantly (IRR = .897, 95% CI = .831-.969), ICU admission rates decreased, and mortality among non-ICU patients rose.

Significance: SE hospitalizations declined over the past decade, without a parallel reduction in mortality. The COVID-19 pandemic further disrupted SE care, with fewer hospitalizations, reduced ICU admissions, and increased mortality among non-ICU patients. Further research is needed to elucidate the factors driving declining incidence and excess mortality.