Abstracts

Rationale: In the United States, approximately one million people annually are evaluated in an emergency department (ED) for the diagnosis of a seizure or epilepsy. The highest percentages of these patients are less than five years of age. No studies have been performed on assessing potential risk factors for recurrent ED visits and/or unplanned hospitalizations for children with epilepsy. Methods: An accountable care organization, Partner for Kids (PFK), database was searched for patients with the highest and lowest number of ED visits and/or unplanned hospitalizations from the years 2007 to 2011 using ICD-9 codes of 345.xx and 780.39. The patients were stratified into a high and low utilizer group. The total number of visits and their associated health care costs were noted for each patient. In total, 120 patients were included for review. Information on the total number of no-shows to outpatient neurology clinic visits and telephone calls to neurology triage nursing was noted. A chart review was performed by a pediatric epileptologist to determine if each individual patient was an appropriate candidate for an emergency seizure treatment. The dose was cross checked to the patient s actual dose during the time of ED or hospital presentation to determine if the dose given was high, low, or accurate based on dosing recommendations. Results: In children with multiple ED visits and/or hospitalizations, 80% were not given correct dose of an emergency seizure medication, while for children in the low utilizer group, only 19% were not given correct dose (p value <0.0001). There is a significant difference in number of no shows and number of phone calls between the two groups. Children with multiple visits had a significantly higher number of no shows to the outpatient neurology clinic (1.78 1.39) compared to children in the low utilizer group (0.37 0.61) (p<0.0001); and children with multiple visits had a significantly higher number of telephone calls to the neurology triage nurses (2.70 4.05) than children in the low utilizer group (0.42 0.96) (p<0.0001).Conclusions: Risk factors appear present for patients with frequent utilization of the ED and/or hospital for children with epilepsy. Most importantly, a major risk factor for frequent use of the ED and/or hospital is an inappropriate or lack of an emergency seizure treatment when needed. Other risk factors include frequent no-shows to clinic visits and increased number of telephone calls to triage nursing. Interventions targeting each risk factor may be useful in decreasing the overall utilization of ED and/or hospitals for children with epilepsy. Future studies are planned to target these risk factors with the goal of decreased ED and/or hospital utilization for children with epilepsy.