Authors :
Presenting Author: Melissa Ly, BS – Wayne State University School of Medicine
Jason Liu, BS – Medical Student, Neurology, Wayne State University School of Medicine; Shatha Wahbi, BS – Medical Student, Neurology, Wayne State University School of Medicine; Maysaa Basha, MD – Chair of Neurology, Neurology, Wayne State University School of Medicine; Deepti Zutshi, MD – Associate Professor, Neurology, Wayne State University School of Medicine
Rationale:
The Centers for Disease Control and Prevention estimated that in 2014, traumatic brain injuries (TBIs) accounted for approximately 2.87 million emergency room visits, hospitalizations, and deaths in the United States. Seizures are a relatively frequent complication of TBI. In the US, epilepsy leads to high utilization of healthcare resources and frequent emergency department (ED) visits, resulting in healthcare costs approximating 9.6 billion dollars annually. The purpose of this study was to analyze the (ED) utilization among chronic TBI patients presenting with seizures in an urban population center.
Methods:
A retrospective study was conducted on all adult patients who visited the ED at the Detroit Medical Center. We obtained data from June 1, 2018 through December 31, 2018 and reviewed a selected cohort of patients presenting with seizures. We collected data on demographics, diagnostic imaging and EEG results, anti-seizure medication and epilepsy history data, hospital admission, discharge disposition, neurology consultation outpatient follow-up visits, and recurrent ED visits for seizures. We excluded patients with a history of seizures who came to the ED for medication refills.
Results:
We reviewed 673 patient encounters who presented to the ED for seizures. Among these visits, we analyzed data on 46 visits in 27 unique patients with a history of chronic TBI. All visits except one were in established patients with post-traumatic epilepsy (PTE). Out of the 46 visits, 16 (34.8%) had at least one imaging scan (CT-Head and/or MRI brain) performed. Normal or chronic findings were seen in 15 (93.8%) of these scans. One patient had an acute intracranial hemorrhage. About 39% of all visits had a neurology consultation placed and had an admission rate of 44.4% versus 10.7% from visits that did not involve a neurology consult. Of the 46 patient visits, 39.1% were admitted to the hospital and all had a length of stay between one day to one week. Nearly 85% of the patient encounters had at least one recurrent ED visit for subsequent seizures and 52% of patient encounters reported missing their medications prior to the ED visit. About 43.5% of patients had one follow-up with outpatient neurology after discharge.
Conclusions:
Patients with PTE experience recurrent visits to the ED for breakthrough seizures with medication non-adherence being the most likely cause for presentation. Repeat neuroimaging in the ED is unlikely to yield new findings. Patients with a neurology consult were more likely to be admitted and those who were admitted were more likely to have admissions lasting between >one day to one week. Further studies are needed to determine which patients would benefit from neuroimaging and to find ways to reduce hospital admissions and recurrent ED visits in patients presenting with breakthrough seizures with a history of chronic TBI.
Funding: N/A