title: Increasing Ketamine Use for Refractory Status Epilepticus in US Pediatric Hospitals.
abstract: Ketamine is an emerging therapy for pediatric refractory status epilepticus. The circumstances of its use, however, are understudied. The authors described pediatric refractory status epilepticus treated with ketamine from 2010 to 2014 at 45 centers using the Pediatric Hospital Inpatient System database. For comparison, they described children treated with pentobarbital. The authors estimated that 48 children received ketamine and pentobarbital for refractory status epilepticus, and 630 pentobarbital without ketamine. Those receiving only pentobarbital were median age 3 [interquartile range 0-10], and spent 30 [18-52] days in-hospital, including 17 [9-28] intensive care unit (ICU) days; 17% died. Median cost was $148 000 [81 000-241 000]. The pentobarbital-ketamine group was older (7 [2-11]) with longer hospital stays (51 [30-93]) and more ICU days (29 [20-56]); 29% died. Median cost was $298 000 [176 000-607 000]. For 71%, ketamine was given ≥1 day after pentobarbital. Ketamine cases per half-year increased from 2 to 9 ( P < .05). Ketamine is increasingly used for severe pediatric refractory status epilepticus, typically after pentobarbital. Research on its effectiveness is indicated.
authors.affiliation: 1 Weill Cornell Medicine, New York, NY, USA.|2 Sanford Children's Hospital, Sioux Falls, SD, USA.|3 New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Keros
authors.affiliation: 4 Boston Children's Hospital, Boston, MA, USA.
authors.forename: Ersida
authors.initials: E
authors.lastname: Buraniqi
authors.affiliation: 1 Weill Cornell Medicine, New York, NY, USA.|3 New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Byron
authors.initials: B
authors.lastname: Alex
authors.affiliation: 4 Boston Children's Hospital, Boston, MA, USA.
authors.forename: Annalee
authors.initials: A
authors.lastname: Antonetty
authors.affiliation: 4 Boston Children's Hospital, Boston, MA, USA.
authors.forename: Hugo
authors.initials: H
authors.lastname: Fialho
authors.affiliation: 1 Weill Cornell Medicine, New York, NY, USA.
authors.forename: Baria
authors.initials: B
authors.lastname: Hafeez
authors.affiliation: 4 Boston Children's Hospital, Boston, MA, USA.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Jackson
authors.affiliation: 1 Weill Cornell Medicine, New York, NY, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jawahar
authors.affiliation: 3 New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kjelleren
authors.affiliation: 3 New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stewart
authors.affiliation: 5 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Morgan
authors.affiliation: 5 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
authors.affiliation: 6 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Sogawa
authors.affiliation: 7 Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Anup D
authors.initials: AD
authors.lastname: Patel
authors.affiliation: 4 Boston Children's Hospital, Boston, MA, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.affiliation: 1 Weill Cornell Medicine, New York, NY, USA.|3 New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Grinspan
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D010424:Pentobarbital / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D007649:Ketamine; D010424:Pentobarbital
keywords: Pediatric Hospital Inpatient System; epilepsy; ketamine; pediatrics; status epilepticus