Abstracts

Hospital readmission rates have been used as an index of quality of care during and after hospitalization.^1–3 There has been an ever-increasing interest in measures to prevent “preventable readmission” to reduce healthcare costs. We conducted a retrospective review of patient records to identify the prevalence of readmissions due to neurological reasons and what factors could lead to preventable readmissions.

A retrospective review of records was done for identifying pediatric patients admitted with epilepsy between 2020-2022. Patients having more than one unplanned admission over a period of one year and related to neurological reasons were included. A previously described standard classification ⁴ was used to categorize them as preventable and non-preventable. Appropriate statistical tests were used to analyze these two groups and identify risk factors for preventable readmissions.

One hundred twenty-three out of 1360 patients who were admitted due to epilepsy had unplanned readmissions. About 47% of these subjects (58) were assessed to be preventable. Preventable readmissions were associated with patients from rural backgrounds (p=0.013), the presence of rescue meds at home (p=0.048), patients with three or more seizure medications, and patients with concomitant intellectual disabilities (p=0.016). On logistic regression analysis, patients from rural counties had an increased risk of preventable readmission. (OR 11.4 (95%CI 2.4-87). Other factors identified with the increased risk, although, with wider confidence intervals included Medicaid (OR 1.8), lower wages (OR 2.3), non-white patients (OR 3.9), subjects with more than two seizure medications (OR 2.8), recent diagnosis in the last three months (OR 1.2), and those with status epilepticus (OR 1.2).

Preventable readmissions in children with epilepsy are increased in patients from rural backgrounds, patients with three or more antiseizure medications, patients with rescue medications, and those with intellectual disabilities. Further studies are required to investigate the role of Medicaid-type insurance, lower-income families, patients belonging to nonwhite races, subjects with recent epilepsy diagnosis in the last three months, a history of status epilepticus, and those on more than two anti-seizure medications. Quality improvement projects identifying these risk factors can help in reducing preventable readmissions.