Trends in hospital mortality of patients with status epilepticus in the ICU before and during the COVID-19 pandemic

The evidence on the temporal trends of short-term mortality among critically ill patients with status epilepticus (SE) is limited and relatively dated, with data lacking on the prognostic impact of the coronavirus disease 2019 (COVID-19) pandemic in these patients. We used statewide data to examine intensive care unit (ICU) admissions with SE aged ≥ 18 years in Texas during 2016 to 2022. Interrupted time series analyses using segmented hierarchical logistic models were fit to estimate trends in hospital mortality during the prepandemic and COVID-19 pandemic periods overall and within age, sex, and race and ethnicity strata, expressed as average marginal effects (AME). Separate hierarchical models were fit to forecast hospital mortality during the pandemic period had the pandemic not occurred (counterfactual). There were 27,885 ICU admissions with SE during the study period (33.1% aged ≥ 65 years, 58.8% racial and ethnic minority, 2.4% with COVID-19, 51.8% mechanically ventilated). Overall hospital mortality was 10.6%. On interrupted time series analyses, hospital mortality decreased during the prepandemic period overall (AME -0.31%/quarter [95% confidence interval -0.39 to -0.23]) and within all demographic strata, except those aged 18 to 44 years, whose hospital mortality was unchanged. During the pandemic period hospital mortality remained unchanged over time overall (AME -0.03%/quarter [95% confidence interval -0.18 to 0.11]) and for all demographic strata, and was consistently higher than counterfactual estimates, including following the exclusion of ICU admissions with COVID-19. Hospital mortality has decreased among critically ill patients with SE prior to the pandemic, except among younger adults. However, these outcome gains were stalled by the COVID-19 pandemic, with increased hospital deaths in this population. Determination of the specific contributions of the disruption in neurological and neuro-critical care support systems and of general health system factors to the adverse outcomes of critically ill patients with SE is paramount for future mitigation and recovery efforts. These data can inform effective implementation of care protocols in SE under population-wide health crises, as well as health policy and resource allocation. Finally, as the pandemic is receding, it is crucial to determine whether there is corresponding recovery of the prepandemic mortality trends in this population.