Abstracts

Rationale: Visits to U.S. Emergency Departments (ED) by patients with seizures account for 1% of all ED visits or 1 million seizure visits annually (Pallin et al. 2008). Overall utilization of EDs in the United States is on the rise, showing a 14% increase between 1992 and 1999 (Cook at al. 2004, McCaig & Burt 1999). The aims of this study were to determine if differences and disparities exist across demographic characteristics, insurance status, and utilization between patients with and without epilepsy or seizure diagnoses using the Emergency Department in Yuma, Arizona. Methods: Emergency Department (ED) data from YRMC between January 2005 to June 2008 were analyzed. Data on individual patients as well as patient visits were analyzed according to whether they had seizure (including epilepsy), epilepsy, or no seizure diagnostic codes in their visits, and whether the patients had ever been admitted to the ED for a seizure or epilepsy-related diagnosis (that is, had a seizure or epilepsy code as the principal diagnosis). Patients who had ever had a seizure diagnosis were coded as seizure patients, and patients who had ever had an epilepsy diagnosis were coded as epilepsy patients (they are also, by default, seizure patients). Results: A total of 40,689 unduplicated patients presented to the YRMC ED from 2005-2008 for a total of 61,851 visits. A seizure diagnosis was present in 3% of all cases that came to the YRMC from 2005-2008, with seizures accounting for 1.74% of all ED visits. Epilepsy related visits accounted for 0.3% of all ED visits. Seizure patients had a high rate of repeat visits across multiple years; 42% of the seizure cohort had multiple yearly visits, the non-seizure cohort had only 15% visiting within two or more years. Seizure patients were 2.76 times more likely to have visits within 2 or more years compared to non-seizure patients. Principal seizure patients had a higher rate of multi-year visits, 43.6% visiting the ED within 2 or more years. Epilepsy and seizure patients were significantly younger than the non-seizure and non-epilepsy cohorts. Conclusions: Epilepsy and seizure patients had high utilization rates within each year and across the study period. Patients who had ever been admitted to the ED due to seizures or epilepsy had higher rates of utilization even if the subsequent admissions were not seizure-related. Insurance status was not a predictor of repeat ED usage by epilepsy patients.