Abstracts

Rationale: Frequent emergency department (ED) use in a child with epilepsy is a behavioral biomarker of poor disease control and/or poor access to care which suggests high quality outpatient care may reduce unnecessary ED and inpatient visits. Thus, frequent ED users are good candidates for enrollment into interventions targeted to disease management in the outpatient setting. However, it is unclear if there are particular comorbidities of epilepsy exist that correlate with frequent ED use. Understanding this relationship would help to design specific interventions for this important population. Methods: We performed a cross-sectional study examining the association between frequency of ED use and epilepsy comorbidity in children (age 0-20) using clinical data from Nationwide Children's Hospital (NCH) and claims data from Partners for Kids (PFK), an accountable care organization (ACO) for Medicaid patients in Central Ohio. We identified children who had an ICD-9 code of 345.xx (epilepsy) or 780.39 (convulsion) based on a 2010 claim. We then reviewed available clinical electronic health records. We classified a child as definite epilepsy if epilepsy was confirmed from chart review and a child as probable epilepsy if the chart was unavailable, but the child had an ICD-9 code of 345.xx. We grouped patients into four levels of ED use: none (0 visits), occasional (1-3 visits), moderate (4-8 visits), and heavy (9 or more visits). We then assessed the presence of 33 epilepsy specific comorbidities by reviewing ICD-9 codes associated with claims. Relevant comorbidities were selected based on three criteria: (1) prevalence of > 10% in at least one category of ED visit frequency, (2) significantly different prevalence in different categories of ED visits frequency (chi-square test), (3) positive correlation between ED category and comorbidity prevalence. Results: Overall, 1996 children had epilepsy (1246 definite, 750 probable). In 2010, 946 (47%) never visited the ED, 832 (42%) visited 1-3 times, 190 (10%) visited 4-8 times, and 28 (1%) visited 9 or more times. Eight comorbidities met the selection criteria, listed in order of overall prevalence: chronic pulmonary disease (overall prevalence 19%), traumatic brain injury (TBI) (6%), cardiac arrhythmia (5%), depression (5%), fracture (4%), hypertension (2%), encephalopathy (1%), and substance abuse (1%). Conclusions: Frequent ED use is common for children with epilepsy. This preliminary work suggests one approach for disease managers to reduce ED use for children with epilepsy is to prioritize (1) improved control of pulmonary disease, (2) counseling for injury avoidance (fracture & TBI), and (3) improved access to psychiatric services (depression & substance abuse). The implications of increased ICD-9 codes for cardiac arrhythmias, hypertension, and encephalopathy are of unclear significance and require further study. Further analysis is ongoing.