Longitudinal Analysis of Neurodiagnostic Testing Utilization in Emergency Department Patients Presenting With Seizures or Epilepsy.

Abstract

The aim of this study was to assess neurodiagnostic testing utilization in US emergency department (ED) patients presenting with seizures or epilepsy between 2006 and2014. Using the largest publicly available all-payer ED database, patients presenting to US EDs between 2006 and 2014 with seizures or epilepsy were identified. Utilization of both pediatric and adult neurodiagnostic testing (head CT, brain MRI, and electroencephalography [EEG]) was assessed. Factors associated with utilization were identified using multivariate logistic regression analyses. A weighted cohort of 9,089,843 patients (27% pediatric, 73% adult) were included. Between 2006 and 2014, annual pediatric ED visits decreased by 1.2%, and adult visits increased by 8.2%. In pediatric patients, head CT utilization increased by 27.8% (from 9% to 11.5% of all visits), MRI increased by 300% (from 0.25% to 1%), and EEG increased by 220% (from 0.5% to 1.6%). In adults, CT, MRI, and EEG increased by 95% (from 12.0% to 23.4%), 400% (from 0.3% to 1.5%), and 650% (from 0.2% to 1.5%), respectively. Using multivariate logistic regression analysis, neurodiagnostic testing utilization was higher in both subgroup populations with male sex, private insurance (versus nonprivate), higher median household income, in the Northeast and South (versus West), and nonteaching hospitals (versus teaching hospitals; all P < .05). Between 2006 and 2014, the use of ED neurodiagnostic testing for seizure and epilepsy increased disproportionately to the frequency of visits. Compared with pediatric patients, neurodiagnostic testing utilization in adults was higher and grew more. Several patient-level and hospital-level factors were associated with higher testing utilization rates.