Epilepsy Admissions Research Articles

Genetic influences on epilepsy outcomes: A whole-exome sequencing and health care records data linkage study.

This study was undertaken to develop a novel pathway linking genetic data with routinely collected data for people with epilepsy, and to analyze the influence of rare, deleterious genetic variants on epilepsy outcomes. We linked whole-exome sequencing (WES) data with routinely collected primary and secondary care data and natural language processing (NLP)-derived seizure frequency information for people with epilepsy within the Secure Anonymised Information Linkage Databank. The study participants were adults who had consented to participate in the Swansea Neurology Biobank, Wales, between 2016 and 2018. DNA sequencing was carried out as part of the Epi25 collaboration. For each individual, we calculated the total number and cumulative burden of rare and predicted deleterious genetic variants and the total of rare and deleterious variants in epilepsy and drug metabolism genes. We compared these measures with the following outcomes: (1) no unscheduled hospital admissions versus unscheduled admissions for epilepsy, (2) antiseizure medication (ASM) monotherapy versus polytherapy, and (3) at least 1 year of seizure freedom versus <1 year of seizure freedom. We linked genetic data for 107 individuals with epilepsy (52% female) to electronic health records. Twenty-six percent had unscheduled hospital admissions, and 70% were prescribed ASM polytherapy. Seizure frequency information was linked for 100 individuals, and 10 were seizure-free. There was no significant difference between the outcome groups in terms of the exome-wide and gene-based burden of rare and deleterious genetic variants. We successfully uploaded, annotated, and linked genetic sequence data and NLP-derived seizure frequency data to anonymized health care records in this proof-of-concept study. We did not detect a genetic influence on real-world epilepsy outcomes, but our study was limited by a small sample size. Future studies will require larger (WES) data to establish genetic variant contribution to epilepsy outcomes.

Disparities by Race and Ethnicity in Inpatient Hospitalizations Among Autistic Adults.

This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.

Incidence of Medication-Related Problems Following Pediatric Epilepsy Admissions

BackgroundAn estimated 26% to 33% of pediatric patients have at least one medication error at hospital discharge. Pediatric patients with epilepsy may be at greater risk due to complex medication regimens and frequent hospitalizations. This study aims to quantify the proportion of pediatric patients with epilepsy experiencing medication problems after discharge and determine if medication education decreases these problems. MethodsThis was a retrospective cohort study including pediatric patients with epilepsy-related hospital admissions. Cohort 1 consisted of a control group, and cohort 2 consisted of patients who received discharge medication education, enrolled in a 2:1 ratio. The medical record was reviewed from hospital discharge to outpatient neurology follow-up to identify medication problems that occurred. The primary outcome was the difference in proportion of medication problems between the cohorts. Secondary outcomes were incidence of medication problems with harm potential, overall incidence of medication problems, and 30-day epilepsy-related readmissions. ResultsA total of 221 patients were included (163 in the control cohort and 58 in the discharge education cohort) with balanced demographics. The incidence of medication problems was 29.4% in the control cohort and 24.1% in the discharge education cohort (P = 0.44). The most common problems were mismatched dose or direction. Medication problems with harm potential were 54.2% in the control group and 28.6% in the discharge education cohort (P = 0.131). ConclusionMedication problems and their harm potential were lower in the discharge education cohort, but the difference was not significant. This demonstrates education alone may not be enough to impact medication error rates.

Air Pollution and Hospital Admission for Epilepsy in Kerman, Iran

Background: This study aimed to investigate the relation between air pollution and epilepsy admissions in Kerman, Iran. Methods: In this ecological study, the concentrations of ambient air pollutants and meteorological data were obtained from Kerman Environmental Protection Agency and Kerman Meteorology Organization, respectively. Additionally, epilepsy admission data were obtained from Kerman’s Shafa hospital epilepsy registry. Generalized additive models with lags up to 7 days were used to estimate rate ratios (RRs). Results: Within 2008 to 2020, 894 epilepsy admissions occurred in Kerman, 498 cases (55.7%) of whom were male. The strongest relations of epilepsy admission were observed in the over 59-year group for carbon monoxide (CO) in lag 0 (RR = 2.1455, 95% CI: 1.5823 - 2.9091), nitrogen dioxide (NO2) in lag 0 (RR = 1.0409, 95% CI: 1.0282 - 1.0537), and particulate matter under 2.5 microns (PM2.5) in lag 5 (RR = 1.0157, 95% CI: 1.0062 - 1.0252). There were also significant associations for particulate matter under 10 microns (PM10) in the under 18-year group in lag 2 (RR = 1.0064, 95% CI: 1.0029 - 1.0098), ozone in lag 0 (RR = 0.9671, 95% CI: 0.9581 - 0.9761), and sulfur dioxide in lag 5 (RR = 0.9937, 95% CI: 0.9891 - 0.9983). Conclusions: Exposure to CO, NO2, PM2.5, or PM10 air pollutants might be a risk factor for epilepsy admissions in Kerman. Epilepsy patients should better stay away from exposure to polluted air. Staying at home on polluted days or residing in areas with less air pollution might be an option.

Readmission and emergency department presentation after hospitalisation for epilepsy in people with intellectual disability: A data linkage study.

Despite the high prevalence of epilepsy and multiple barriers to care in people with intellectual disability, the risk of returning to hospital after an admission for epilepsy is largely unknown. In this study, we sought to quantify and compare readmission and emergency department (ED) presentations after hospitalisation for epilepsy in people with and without intellectual disability. Using linked administrative datasets, we conducted a retrospective cohort study of people aged 5-64 years with an acute hospitalisation for epilepsy from 2005-2014 in New South Wales, Australia. Acute readmission and ED presentation rates within 30, 90, and 365 days of the index hospitalisation were estimated and compared between people with and without intellectual disability using modified Poisson regression. Of 13537 individuals with an index hospitalisation, 712 children and 1862 adults had intellectual disability. Readmission and ED presentation after the index hospitalisation were common in people with intellectual disability. Within 30 days, 11% of children and 15.6% of adults had an all-cause readmission and 18% of children and 23.5% of adults had an ED presentation. Over 60% of both children and adults presented to an ED within a year. Neurological, respiratory, and infectious conditions were overrepresented reasons for readmission in people with intellectual disability. Age-adjusted relative risks (RRs) within each period showed a higher risk of readmission and ED presentation in children and adults with intellectual disability than without. Most RRs remained statistically significant after controlling for covariates. The largest adjusted RRs were observed for readmission for epilepsy (RR 1.70, 95% CI: 1.42 to 2.04) and non-epilepsy related conditions (RR 1.73, 95%: CI 1.43 to 2.10) in children. Study limitations include lack of clinical data. Increased risk of returning to acute care after epilepsy hospitalisation suggests there is a need to improve epilepsy care for people with intellectual disability. We recommend research into strategies to improve management of both seizures and comorbidity.

Epilepsy and proxy-reported health-related quality of life in children and young people with non-ambulatory cerebral palsy.

To assess the association between epilepsy characteristics and proxy-reported health-related quality of life (HRQoL) in children and young people with non-ambulatory cerebral palsy (CP) and seizures. This was a cross-sectional study of 164 children and young people (74 females, 90 males; mean age 10 years 6 months, range 2-21 years, SD 5 years 5 months). Caregivers completed the Child Health Index of Life with Disabilities (CPCHILD) in an outpatient setting. We utilized univariable linear regression and multivariable modeling to study relationships between variables and CPCHILD scores. Gross Motor Function Classification System levels were 37% IV and 63% V. Sociodemographic factors included the Child Opportunity Index (median 51, interquartile range [IQR] 25-80). A median of 2 (IQR 1-3) antiseizure medications (ASMs) were used, and days with seizures ranged from 0 (30%) to 28 (20%) days in the previous 4 weeks. Total CPCHILD scores decreased 2.3 points for each ASM (95% confidence interval [CI] -4.1 to -0.42). Compared to persons with focal epilepsy, those with generalized epilepsy had lower total CPCHILD scores (-5.7; 95% CI -11 to -0.55). Number of days with seizures was not associated with total CPCHILD scores. Proxy-reported HRQoL was affected by epilepsy-specific features in children and young people with severe CP. Health-related quality of life (HRQoL) was lower with increasing numbers of antiseizure medications. Overall quality of life (QoL) scores were lower by a similar amount, independent of seizure frequency. HRQoL was lower in persons with recent hospital admissions for epilepsy.

The Cost Analysis of a 7-Year Cross-Section of Patients with Epilepsy in a Single-Center Child Neurology Outpatient Clinic: A Descriptive Retrospective Analysis

AbstractThe cost analysis of the 7-year cross-section of the patients in pediatric neurology outpatient clinic including patients with foreign nationality was investigated retrospectively. Between January 10, 2013 and January 10, 2020, the total number of applicants, the nationalities of the patients, and the hospital cost were analyzed. Of 3,338 patients, aged between 0 and 20 years with mean age of 8.7 years at admission to the child neurology had received 17,476 clinical examinations. Of these, 51.6% were male and 93.5% cases were Turkish patients (n = 3,122), with 6.5% foreign nationals (n = 216). There was no difference in terms of gender between nationalities (p &gt; 0.05). The total cost of cases with epilepsy was 1,312,427.73 Turkish Lira (TRY) and 6.2% account belonged to foreign nationals, mostly from Iraq (3.6%, n = 119) and Syria (2.4%, n = 80). The highest proportion of foreigner admissions due to epilepsy was in 2018 (11.1%). Mean average of health expenditures for foreign nationals diagnosed with epilepsy was 6.2% with the highest expenditure in 2019 (27.750,06 TRY). The proportion of admissions for epilepsy was 27.6% (17,476/63,173) among all neurological admissions. The proportion of Turkish patients was 25.6% (6,181/63,173), and 3.8% (1,295/3,398) accounted for foreigners' admissions. The proportion of total epilepsy costs compared with the total neurological admissions was 30% (1.312.427,73 TRY/4.347.592,80 TRY) and among them, the expenditure proportion for epilepsy in Turkish patients compared with that of total foreigner admissions was 3.9% (80.416,44 TRY/201.490,515 TRY). Expenditures for evaluating of epileptic children with foreign nationality cover an average of 6.5% of the entire section of the health expenditures made for patients with the diagnosis of epilepsy in the pediatric neurology outpatient clinic over the 7-year period. Epilepsy accounts for 30% admissions among all neurological admissions with 3.9% belonging to foreign national admissions.

Impact of COVID-19 pandemic on epilepsy care in Japan: A national-level multicenter retrospective cohort study.

ObjectiveThe impact of the coronavirus disease 2019 (COVID‐19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study.MethodsThis study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy center‐specific monthly data divided by the 12‐month average in 2019 for each facility. We determined whether the COVID‐19 pandemic‐related factors (such as year [2019 or 2020], COVID‐19 cases in each prefecture in the previous month, and a state of emergency) were independently associated with these outcomes.ResultsIn 2020, the frequency of outpatient EEG studies (−10.7%, P < .001) and cases with telemedicine (+2608%, P = .031) were affected. The number of COVID‐19 cases was an independent associated factor for epilepsy admission (−3.75 × 10−3% per case, P < .001) and EEG monitoring (−3.81 × 10−3% per case, P = .004). Furthermore, a state of emergency was an independent factor associated with outpatient with epilepsy (−11.9%, P < .001), outpatient EEG (−32.3%, P < .001), telemedicine for epilepsy (+12,915%, P < .001), epilepsy admissions (−35.3%; P < .001), EEG monitoring (−24.7%: P < .001), and epilepsy surgery (−50.3%, P < .001).SignificanceWe demonstrated the significant impact that the COVID‐19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic‐related factor on epilepsy care.

Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance.

Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases.Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure.Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure.Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.

Persistent racial and ethnic disparities as a potential source of epilepsy surgery underutilization: Analysis of large national datasets from 2006–2016

ObjectiveHigh volume surgical epilepsy centers have reported a decrease in surgical resections and an increase in intracranial monitoring. Despite this increase in complexity, epilepsy surgery remains significantly underutilized. The goal of this study is to examine the utilization of and access to epilepsy surgery in the United States from 2006 to 2016. MethodsWe used administrative datasets from the National Inpatient Sample (NIS) and Center for Medicare and Medicaid Services (CMS) to report national estimates of epilepsy surgery and changes in surgery types. We also examined disparities and barriers in access to epilepsy surgery. ResultsInpatient epilepsy admissions increased from 2.41 to 5.78 per 100,000 between 2006 and 2016, while surgical epilepsy admissions plateaued after 2011. Open resections comprised 75 % of all surgical cases from 2006 to 2011 then decreased each year to 50 % in 2016 with both temporal and extratemporal resections decreasing proportionally. Intracranial monitoring increased in the last two years of the study due to an increase in SEEG/depth electrode cases. The multivariate analysis showed that patients with Medicaid (OR 0.75, 95 % CI 0.67−0.83) and Medicare (OR 0.62, 95 % CI 0.54−0.70) were significantly less likely to undergo epilepsy surgery compared to those with private insurance. Black patients were less likely to undergo epilepsy surgery than White or Hispanic patients (OR 0.57, 95 % CI 0.49−0.67). No significant difference was found in epilepsy surgery rates after implementation of the Affordable Care Act (ACA) in 2014. ConclusionThis study identifies recent trends in epilepsy surgical approaches and suggests that improving access to care does not necessarily address disparities present in the treatment of epilepsy patients who need surgical care.

PND31 Comparison of Burden of Hospitalizations in Epilepsy, Migraine and Sleep Disorders: A Propensity Score Matched Analysis of In-Patient Claims Database

To compare trends in hospital length of stay, total costs and comorbidities in Epilepsy, Migraine and Sleep disorders. The 2016 National Inpatient Sample (NIS) data set from the Healthcare Cost and Utilization Project was utilized in order to determine the number of hospital admissions for Epilepsy, Migraine and Sleep disorders. Propensity score matched analysis was conducted to compare hospital LOS and costs in selected patients. Thirty comorbidities were assessed using Elixhauser scoring. Multivariate logistic regression was conducted to assess predictor variables for LOS and costs. In 2016, Sleep disorders had significantly higher number of hospitalizations compared to Epilepsy and Migraine (3.06 million versus 1.19 million and 0.59 million visits, respectively). The patients with sleep disorders were older than patients with Epilepsy and Migraine (61.47 [SD 16.33] versus 52.11 [SD 22.16] and 47.83 [SD 17.14] years, respectively). Vast majority of Migraine patients were female (81%) compared to patients with Epilepsy (51%) and Sleep disorders (46%). Most Epilepsy (49%) and Sleep disorders (57%) patients were covered by Medicare, while for Migraine (39%), Private insurance was the main payer. The mean hospital LOS was longest for Epilepsy (6.03 [SD 8.91] days), followed by Sleep disorders and Migraine (5.41 [SD 6.84] and 4.22 [SD 5.03] days, respectively). Similarly, mean charges were highest for Epilepsy, followed by Sleep disorders and Migraine ($59335, $58790 and $45096, respectively). Hypertension and Chronic Pulmonary Disease were the two most common comorbidities across the three groups. Epilepsy, Migraine and Sleep disorders lead to high resource use due to high rate of hospitalizations and long length of stay. There is a need for better management of patients with these disorders.

One-Year Readmission and Emergency Department Presentation After an Epilepsy-Related Admission in People with Intellectual Disability: A Registry-Linkage Study

IntroductionIntellectual disability (ID) is a neurodevelopmental condition that affects approximately 1-2% of the population, and epilepsy is a common comorbidity in people with ID. Although hospital admission for epilepsy is also common, little is known about the impact of ID on healthcare use following an epilepsy admission.&#x0D; Objectives and ApproachUsing linked administrative health datasets that included hospital admissions and disability service data, we aimed to examine whether the presence of ID led to greater or lesser use of healthcare services following an epilepsy admission, as represented by all-cause unplanned readmissions and emergency department (ED) presentations. Comparing the rate of readmissions and ED presentations within 30, 90 and 365 days of the first epilepsy admission during the study period, the effect of ID was assessed using Poisson regression.&#x0D; ResultsA total of 18,987 patients had an epilepsy admission between 2005 and 2014, and of these, 3,256 (17.1%) had ID. Compared to patients without ID, patients with ID had a higher risk of unplanned readmissions within each follow-up period (adjusted incidence rate ratio (IRR) with 95% CI: 30 days: 1.48 (1.34, 1.65); 90 days: 1.42 (1.31, 1.54); 365 days: 1.49 (1.40, 1.59)). Differences were also found in the reasons for readmission, including more readmissions for neurological disorders. Similarly, the ED presentation risk was elevated in patients with ID (adjusted IRR: 30 days: 1.34 (1.23, 1.46); 90 days: 1.33 (1.24, 1.42); 365 days: 1.38 (1.30, 1.46)).&#x0D; Conclusion / ImplicationsIn patients with epilepsy, the presence of ID appears to increase the chance of a readmission or ED presentation following a hospital admission for epilepsy, with the reasons for readmission also potentially different. This suggests the potential for improvements in post-admission screening and management.

Epilepsy and Seizure-Related Hospital Admissions to an Australian Neurology Unit: A Prospective Observational Study

This study provides contemporary data on patients admitted to a Neurology unit with seizures, the majority of whom have a diagnosis of epilepsy. There were 278 hospital presentations with seizure during the 6-month study period, with 60 admissions to the Neurology unit included for analysis. Provoking factors were identified in 40%, with poor medication adherence the commonest precipitant. CT-brain had low diagnostic yield in patients with epilepsy presenting with seizure and should be reserved for those with further indications for imaging. Patients with drug-resistant epilepsy comprised 54% of admissions suggesting management strategies in this cohort can be further optimized.

Healthcare utilization and associated costs following initiation of perampanel in patients with epilepsy

PurposeWe compared health service utilization and costs for patients with epilepsy before and after initiation of perampanel and compared with matched controls. MethodPatients were selected from the Clinical Practice Research Datalink (CPRD). Patients initiating perampanel were matched to controls initiating an alternate add-on therapy for the same underlying epilepsy subtype. First prescription defined index date. Primary and secondary care contacts and associated costs were aggregated in the 12 months before and after index date. Secondary care contacts were available for a subset (~60%) of patients. ResultsThree hundred and forty-three patients treated with perampanel were identified. One hundred and eighty-three (53.4%) were male, mean age was 39.1 (sd: 16.0). Mean epilepsy duration was 21.1 (standard deviation (sd): 13.3) years. Two hundred and eighty-seven (83.7%) were matched to controls. Inpatient admissions with a primary diagnosis of epilepsy (0.5 versus 0.2 per patient-year (ppy), p = 0.002) and neurology specific outpatient appointments (3.2 versus 2.9 ppy, p = 0.041) were significantly reduced following initiation with perampanel. Total costs attributable to epilepsy (£1889 to 1477 ppy) and overall secondary costs (£2593 to £2102) were also significantly reduced. There was no significant difference in primary care, outpatient, or general inpatient admissions. Compared with controls, there was a significant reduction in primary epilepsy admissions (incidence rate ratio (IRR): 0.423; 95% Confidence intervals (CI): 0.198–0.835) but a significant increase in outpatient appointments (1.306; 95% CI: 1.154–1.478) and accident and emergency contacts (1.603; 95% CI: 1.081–2.390) for patients treated with perampanel. ConclusionTreatment with perampanel is associated with reduced epilepsy-related inpatient admissions and accident and emergency contacts.

Exacerbation of hepatic cirrhosis may trigger admission for epilepsy and status epilepticus.

To determine whether acute exacerbations of cirrhotic liver disease are associated with higher odds of readmission for epilepsy or status epilepticus. The New York State Inpatient Database is a statewide dataset containing data on 97% of hospitalizations for New York State. In this retrospective, case-crossover design study, we used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify index status epilepticus and epilepsy admissions. The primary exposure was defined as admission due to an acute exacerbation of cirrhotic liver disease. The case-crossover analysis tested whether exposure to a hepatic exacerbation within progressively longer case periods (14, 30, 60, 90, 120, 150, and 180days before index admission), compared to control periods 1year before the case period, was associated with readmission for epilepsy or status epilepticus. The odds ratio for subsequent admission for epilepsy after exposure to an acute exacerbation of cirrhotic liver disease was significant in the 30-day window at 2.072 (95% confidence interval [CI] = 1.095-3.92, P=.0252) and peaked in the 150-day window at 2.742 (95% CI = 1.817-4.137, P<.0001). In the status epilepticus group, all case periods demonstrated significantly elevated odds of subsequent admission following hepatic exacerbation. Hepatic exacerbations are associated with increased odds for hospital admissions for epilepsy and status epilepticus across several timeframes.

Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability

To examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability. We conducted a retrospective cohort study using linked health administrative and disability data from Western Australia (WA) and New South Wales (NSW). Children born between 1983 and 2009 in WA and 2002 and 2010 in NSW who had a gastrostomy insertion performed (n=673 [WA, n=325; NSW, n=348]) by the end of 2014 (WA) and 2015 (NSW) were included. Conditional Poisson regression models were used to evaluate the age-adjusted effect of gastrostomy insertion on acute hospitalizations for all-cause, acute lower respiratory tract infections (LRTI), and epilepsy admissions. The incidence of all-cause hospitalizations declined at 5years after procedure (WA cohort 1983-2009: incidence rate ratio, 0.70 [95% CI, 0.60-0.80]; WA and NSW cohort 2002-2010: incidence rate ratio, 0.63 [95% CI, 0.45-0.86]). Admissions for acute LRTI increased in the WA cohort and remained similar in the combined cohort. Admissions for epilepsy decreased 4years after gastrostomy in the WA cohort and were generally lower in the combined cohort. Fundoplication seemed to decrease the relative incidence of acute LRTI admissions in the combined cohort. Gastrostomy was associated with health benefits including reduced all-cause and epilepsy hospitalizations, but was not protective against acute LRTI. These decreases in hospitalizations may reflect improved delivery of nutrition and medications.

Risk of readmission for injury in patients with epilepsy in the United States – A population-based study

ObjectiveThe objective of this study was to determine the 30-day injury readmission risk among persons with epilepsy vs. without epilepsy using a nationally representative US database. Secondary objectives were to examine the factors associated with injury-related readmissions among those with epilepsy and identify specific causes of readmissions within 30 days of index admission. MethodsHospitalized individuals of all ages with epilepsy as the primary diagnosis were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in the 2014 Nationwide Readmission Database (NRD). Primary outcome was 30-day readmission for an injury defined by ICD-9-CM diagnosis codes following discharge from index hospitalization. Subgroup differences in the groups with epilepsy and without epilepsy were estimated using standardized mean difference scores that are calculated with means and variances of the covariates. Multinomial logistic regressions were conducted to determine the 30-day injury readmission risk and examine the factors associated with injury-related readmissions. ResultsThere were 60,074 unique persons with epilepsy (mean age: 42.53 years, female: 49.32%) and 9,282,952 without epilepsy (mean age: 44.46 years, female: 59.43%). A higher proportion of persons with epilepsy (n = 215, 0.34%) vs. without epilepsy (n = 22,783, 0.22%) had a 30-day readmission due to an injury. After adjusting for covariates, persons with epilepsy had higher odds of 30-day readmission due to an injury (adjusted OR: 1.40, 95% CI: 1.20–1.62, p < 0.0001). Factors associated with an injury-related readmission in persons with epilepsy include the following: increasing age (OR: 1.01, 95% CI: 1.00–1.02, p = 0.02), transfer to short term hospital/other facility (OR: 1.50, 95% CI: 1.00–2.27, p = 0.05), discharged against medical advice/discharge destination unknown (OR: 2.26, 95% CI: 1.40–4.45, p = 0.02), and higher Elixhauser comorbidity index (OR: 1.02, 95% CI: 1.01–1.03, p < 0.0001). ConclusionsHigher odds of 30-day injury readmissions were observed in persons with epilepsy vs. without epilepsy. Optimizing the management of comorbid conditions during the patient's index admission for epilepsy, minimizing discharges against medical advice, and fostering outreach programs to those who have been transferred to short-term hospitals or facilities may reduce 30-day readmissions due to an injury.

One-year readmission and Emergency department presentation after an epilepsy admission in people with intellectual disability: a registry-linkage study

Background with rationaleAlthough hospital admissions for epilepsy are common in people with intellectual disability (ID), little is known about the quality of inpatient care and outcomes after admission. To fill this gap, this project examines readmission, an important indicator for the quality of hospital care, and emergency department (ED) presentation after epilepsy admissions in people with ID compared to those without ID.&#x0D; Main AimTo examine whether people with ID have a higher risk of all-cause readmissions and ED presentations after discharge from the index admission (i.e. first admission within the study period) for epilepsy than people without ID.&#x0D; MethodsIn this retrospective data-linkage study, several linked administrative health datasets including but not restricted to hospital admissions, emergency department presentations, disability services and mental health ambulatory care are used to define the cohort, exposure and outcome. The cohort includes patients with and without ID who were admitted to hospital for epilepsy between 2002 and 2014 in New South Wales, Australia. The readmission rates and ED presentations within 28 days, 2-3 months, 4-6 months, and 7-12 months respectively will be compared between patients with and without ID. The effect of a diagnosis of ID on the risk of readmission and ED presentation within a year following the separation from the index admission will be estimated by Poisson regression.&#x0D; Results and conclusionsThe demographics and comorbidity profile of participants at the index epilepsy admission will be presented. Readmission and ED presentation rates within each chunk of follow-up will be calculated by the status of ID and the incidence rate ratio will be provided to estimate the impact of ID on these outcomes. Findings will provide insight into how patients with ID and epilepsy fare in hospital care and help to guide future management of epilepsy in people with ID.

Admissions for orthostatic hypotension: an analysis of NHS England Hospital Episode Statistics data

ObjectivesTo determine whether admissions for orthostatic hypotension (OH) and its consequences, such as falls, have changed over the past 10 years in the National Health Service (NHS) England.SettingData from NHS...

Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study

Concerns have been raised about variation in care quality and outcomes among children and young people with epilepsies in England. We aimed to investigate the association between quality of paediatric care, hospital admissions, and all-cause deaths among epilepsy patients. In this longitudinal data linkage study of paediatric epilepsy services in England, we linked unit-level data from round 1 (2009-11) and round 2 (2013-14) of the Epilepsy12 national clinical audit, with death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics. We investigated the association between unit-level performance in involving a paediatrician with epilepsy expertise, an epilepsy specialist nurse, and a paediatric neurologist (where appropriate) in round 1 and the proportion of adolescents (aged 10-18 years) with epilepsy admitted to each unit who subsequently died during the study period (April 1, 2009, to March 31, 2015). We also investigated whether change in Epilepsy12 performance between the two audit rounds was associated with changes in the standardised ratio of observed-to-expected unplanned epilepsy admissions over the same period. In 99 units with data for the analyses relating to paediatricians with epilepsy expertise and epilepsy specialist nurses, 134 (7%) of 1795 patients died during the study period, 88 (5%) of whom died after the transition to adult service. In 55 units with data for the analyses relating to paediatric neurologists, 79 (7%) of 1164 patients died, 54 (5%) of whom did so after the transition. In regression models adjusting for population, unit, and hospital activity characteristics, absolute reductions in total mortality risk (6·4 percentage points, 95% CI 0·1-12·7) and mortality risk after transition (5·7 percentage points, 0·6-10·8) were found when comparing units where all versus no eligible patients were seen by a paediatric neurologist. Units where all eligible patients were seen by a paediatric neurologist were estimated to have absolute reductions of 4·6 percentage points (0·3-8·9) in total mortality and of 4·6 percentage points (1·2-8·0) in post-transition mortality, compared with units where no or some eligible patients were seen by a paediatric neurologist. There was no significant association between performance on being seen by an epilepsy specialist nurse or by a paediatrician with epilepsy expertise and mortality. In units where access to an epilepsy specialist nurse decreased, the standardised ratio of epilepsy admissions increased by a mean of 0·21 (0·01-0·42). Among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services. Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions. The Health Foundation.