OBJECTIVES: Status epilepticus (SE) is a neurologic emergency requiring urgent diagnosis and treatment to prevent neurologic sequelae. SE may present as a complication of an underlying illness, exacerbation of baseline epilepsy disorder, or without known underlying etiology in both the community or academic medical center setting. This study examined care settings and inter-hospital transfer characteristics in the management of SE.

METHODS: Hospital-based, service-level, all-payer US data from PINC AI™ Healthcare Database (2018-22) and payer-complete patient-level claims from Komodo Healthcare Map linked with Komodo Hospital Insights (KHI) (2017-22) were analyzed. SE episodes were identified by ICD-10 CM code and segmented according to IV anesthesia (IVA) and mechanical ventilation exposure into established SE (ESE) and refractory SE without or with IVA (RSE-noIVA, RSE-IVA). Super-refractory SE (SRSE) was a subset of RSE-IVA episodes (IVA and mechanical ventilation for ≥2 days).

RESULTS: 140,538 SE episodes in 113,229 unique patients were analyzed within PINC AI™; 48,483 (34%) episodes involved ≥1 inter-hospital transfer; 13,839 (10%) offered treatment visibility up to first transfer. Most (83%) patients were transferred after 1^st- or 2^nd-line treatment. 203,176 episodes in 146,408 unique patients were analyzed in Komodo Claims; 65,545 (32%) episodes required ≥1 transfer. Initial admissions among episodes requiring a transfer were evenly split between community (51%) and academic (49%) settings, however the majority (66%) were discharged from an academic facility. Analysis of 3,566 linked claims + KHI episodes involving transfers demonstrated that transfer rates increased with higher treatment intensity: 30% (614/2025) of patients with ESE episodes transferred during the episode versus 36% (719/2008) of RSE-noIVA, 43% (955/2227) of RSE-IVA, and 48% (578/1199) of SRSE episodes.

CONCLUSIONS: Increased treatment intensity was associated with increased need for inter-hospital transfers. A high proportion of admissions at community facilities were transferred to academic institutions, highlighting a need for coordinated efforts to provide optimal care.