552 Exploring geographic variation in epilepsy admissions and diagnosis among children and young people across England

Abstract

<h3>Aims</h3> To investigate geographic variation in epilepsy admissions and new epilepsy diagnoses among children and young people (CYP) aged under 18, in England. Outliers in hospital admissions and new diagnosis rates will be studied to explore common factors and inform quality improvement efforts. <h3>Methods</h3> This study involved a retrospective secondary analysis of quantitative data. Trust catchment populations were calculated based on the proportion of CYP from surrounding local areas that attend each hospital, using Hospital Episode Statistics Admitted patient care (HES-APC) data and Office for National Statistics data on Lower Super Output Areas, which are small geographic areas. HES-APC data for emergency admissions between April 2018 and March 2019, and Epilepsy12 audit data between July-November 2018, were accessed to measure 1) Trust level admission rates per 100,000 CYP for admissions with a primary diagnosis of epilepsy and 2) Trust level new epilepsy diagnosis rates per 100,000 CYP, respectively. The ratio of observed versus expected epilepsy admissions were calculated for each Trust. The expected admission rates for each Trust were calculated by multiplying the national epilepsy admission rate for CYP by the total catchment population for that Trust. The expected new diagnosis of epilepsy rate was calculated for each Trust by multiplying the total number of new diagnosis in Epilepsy12 by the total catchment population for that Trust. Results were adjusted for age, sex, and deprivation. Trusts with admission and diagnosis rates that differed by more than three standard deviations from the expected rate for their population were identified. <h3>Results</h3> There were 9246 emergency admissions for CYP with a primary diagnosis of epilepsy in England between March 2018 and April 2019. Standardised admission rates with a primary diagnosis of epilepsy ranged from 11.5 to 170.6 per 100,000 CYP (14.8-fold variation). The median value was 68.7 per 100,000 with an interquartile range (IQR) from 55.7 to 90.6 admissions per 100,000 CYP. Variations in emergency admissions for epilepsy exist after considering total emergency admissions for CYP for any cause at a Trust level. There were 960 new diagnoses of epilepsy between July and November 2018 for CYP in England, for Trusts where the catchment population could be calculated. Standardised diagnosis rates for a new diagnosis of epilepsy ranged from 3.1 to 27.0 per 100,000 CYP (8.6-fold variation). The median value was 13.6 per 100,000 CYP with an IQR from 10.9 to 16.6. There does not appear to be a link between Trusts having a tertiary neurology centre and higher rates of new epilepsy diagnosis. Geographic mapping reveals higher than expected rates of diagnosis and admissions for epilepsy in the North East of England, when compared to the South of England and London. <h3>Conclusion</h3> Widespread unexplained variation in epilepsy admissions and diagnosis raises concerns about the equity, quality, and accessibility of epilepsy services. Further work is needed to investigate the causes of this wide variation.