Abstracts

Rationale: Epilepsy is a common neurologic condition and accounts for 1% of the global burden of disease (1). Nearly one-third of patients are unable to maintain a seizure-free state even with the anti-epilepsy medication (2). Seizures account for about 1 million of emergency room (ER) visits in the US or 1% of ER visits in US (3, 4). However, it is not known how many people have repeat ER visits for uncontrolled epilepsy. Methods: We examined patients 18 years and older who came to emergency room with primary diagnosis of epilepsy (ICD9 code 345 and 780.39) in the state of California from 2005-2011. Emergency department visits that did not result in transfer to hospital or death were chosen as index visits. Patients with these index ER visits were followed for one year to determine the number of times they revisited the ER or were hospitalized with a primary diagnosis of epilepsy within the 30, 60, 90, 180 days and 1 year following the index visit. Data on ED visits were obtained from the California State Emergency Department Database (SEDD) and hospitalization records from the California State Inpatient database (SID), covering all records from community hospitals in California. Epilepsy patients were identified by ICD9 codes 345 and 780.39. Prior studies have demonstrated a positive predictive value (PPV) for a diagnosis of epilepsy of 98.9% for ICD 9 code 345.xx, and a PPV of 84% for 345 and 780.39 combined (5). Results: In California, there were 64,653,918 all cause total ER visits from 2005-2011. Out of these, 365,698 visits (in 162,294 patients 18 years or older) were for a primary diagnosis of epilepsy. A total of 158,182 patients were followed for 1 year after an index ER visit that did not result in hospitalization/death/ or readmission to another hospital on the same day. Table 1 shows details of repeat ED visits and hospitalizations. Within 30 days of index ER visit, 9,933 patients (6.3%) had to visit the ER 12,467 times and 2,809 patients (1.8%) were hospitalized 2,973 times. At 60 days, 90 days, 180 days and 1 year the revisits to ER were in 9.7%, 12.4%, 17.7% and 24.2% patients respectively; and hospitalization in 2.5%, 3.1%, 4.5% and 6.4% patients respectively. Within 1 year 37,652 patients (24.2%) presented to the ER 73,103 times and 9,956 patients (6.4%) had to be hospitalized 12,934 times. The cumulative numbers of deaths were 430, 708, 940, 1,558 and 2,536 at 30, 60, 90, 180 days and 1 year respectively. Conclusions: Almost 1 in 3 patients who visit the ER for a primary diagnosis of epilepsy are forced to return back again to ER or are hospitalized for epilepsy within one year. It is likely that many of these repeat ER visits and hospitalizations are preventable with better disease recognition and clinical care. Aggressive seizure control in outpatient management remains critically important for these patients. References: 1. Global Burden of Disease Study, C. (2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013." Lancet 386(9995): 743-800. 2. Brodie, M.J., Barry, G. A. Bamagous, J. D. Norrie and P. Kwan (2012). "Patterns of treatment response in newly diagnosed epilepsy." Neurology 78(20): 1548-1554. 3. Pallin DJ, Goldstein JN, Moussally JS, et al. Seizure visits in US emergency departments: epidemiology and potential disparities in care. Int J Emerg Med 2008;1:97-105. 4. Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am 2011;29:15-27 5. Jette, N., A. Y. Reid, H. Quan, M. D. Hill and S. Wiebe (2010). "How accurate is ICD coding for epilepsy?" Epilepsia 51(1): 62-69. Funding: This study was supported by a research grant from Acorda Therapeutics.