The unconditional probabilities of survival were estimated by weighted Kaplan-Meier analysis. Inverse probability of treatment weighting (IPTW) was used to balance baseline demographics and clinical characteristics between treatment groups. Participants were followed up until the date of their last clinical encounter, in-hospital death, or Dec 31, 2020. Patients treated with at least three types of antiseizure medications were included in the medical therapy cohort, those treated with antiseizure medications plus VNS were included in the VNS cohort, and those treated with antiseizure medications plus cranial epilepsy surgery were included in the surgery cohort. In this observational cohort study, patients aged 0-17 years who were diagnosed with drug-resistant epilepsy using International Classificiaton of Diseases codes between Jan 1, 2004, and Dec 31, 2020, were identified from the Pediatric Health Information System, an administrative database that contains inpatient, emergency department, ambulatory, and observation unit encounter-level data from more than 49 children's hospitals in the USA. We aimed to compare the long-term survival rates associated with antiseizure medications only, antiseizure medications plus vagus nerve stimulation (VNS), and antiseizure medications plus cranial epilepsy surgery in paediatric patients with drug-resistant epilepsy using a large national administrative database in the USA. A better understanding of treatment effects on mortality in paediatric patients with drug-resistant epilepsy is needed for health-care decision making. Long-term survival in paediatric epilepsy is incompletely characterised.
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