Abstracts

Rationale: Evaluation of patients with seizure disorders in EMU is a standard practice. The purpose of this study was to evaluate short- and intermediate-term outcomes of patients after discharge from EMU. Methods: All patients admitted from 12/1/15- 6/1/16 were eligible to participate. Demographics over the last 3 months regarding seizure frequency, number of AEDs, number of visits with neurologist, ER visits, and hospital admissions were collected on admission. Data collection continued at 1-2 weeks, 6-8 weeks and 3-4 months from the date of discharge. Standard statistical methods were used for comparisons between time points (paired-samples t-tests). Linear regression was used to determine the effects of internal vs. external follow-up. Results: Of the 259 patients, 18 % had non?"lesional temporal lobe epilepsy, 9% non-lesional extra-temporal lobe epilepsy, 1% lesional epilepsy, 6% idiopathic generalized epilepsy, 4% symptomatic generalized epilepsy, 28% PNES, 5% PNES + epilepsy, 7% physiologic events, and 22% non-diagnostic studies. Fifty percent were referred internally (N=129) to providers affiliated with UAB neurology, and 43% (N=111) were referred externally (providers not-affiliated with UAB). Pre-admission variances between groups were subtle and included differences in number of AEDs (2.1 vs 1.7; p=0.027; internal vs. external), and differences in number of visits to neurologists (1.2 vs. 0.8; p=0.000). Significant changes in outcome measures were noted at all time points for follow up. At 1-2 weeks (N=152): seizure frequency 4.8 11.4 vs. 2.4 7.3 (p=0.000), number of AEDs 2.0 1.2 vs. 1.8 1.4 (p=0.008), visits to neurologist or other provider 1.1 0.8 vs. 0.1 0.4 (p=0.000), ER visits 0.3 0.8 vs. 0.05 0.2 (p=0.000), rate of hospital admission 0.09 0.3 vs. 0.0 (none; p=0.000); at 6-8 weeks (N=103): seizure frequency 5.2 13.3 vs. 2.6 7.7 (p=0.002), number of AEDs 1.9 1.0 vs. 1.7 1.2 (p=0.032), visits to neurologist or other provider 1.1 0.9 vs. 0.4 0.5 (p=0.000), ER visits 0.4 0.9 vs. 0.08 0.3 (p=0.000), hospital admission 0.1 0.3 vs. 0.01 0.1 (p=0.001); at 3 months (N=68): seizure frequency 15.4 65.0 vs. 8.1 42.7 (p=0.017), number of AEDs 1.9 1.1 vs. 1.6 1.3 (p=0.028), visits to neurologist or other provider 1.1 0.8 vs. 0.7 0.7 (p=0.001), ER visits 0.5 1.0 vs. 0.05 0.2 (p=0.000), hospital admission 0.13 0.3 vs 0.04 0.2 (p=0.057). When comparing pre-admission number of ER visits, linear regression showed internal (compared to external) follow-up resulted in less frequent ER visits (p=0.047). There were no other significant differences, but internal follow up data is trending towards improved outcomes in quality of care. Conclusions: Patients evaluated and discharged from EMU demonstrate improved outcomes such as enhanced AED adjustments and lower seizure burden, decreased frequency of outpatient and ER visits, and hospital admissions. The relationship between follow-up (external vs. internal) requires further evaluation in a larger number of patients. Funding: N/A