Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization

Manjunath, Ranjani; Paradis, Pierre Emmanuel; Parisé, H.; Lafeuille, Marie-Hélène; Bowers, Brian; Duh, Mei Sheng; Lefèbvre, Patrick; Faught, Edward

doi:10.1212/wnl.0b013e318271f77e

Cited by 104 publications

(99 citation statements)

References 19 publications

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“…10,11 16 further articles/sources which were considered relevant by the authors but not captured by the original search were also included. 4,[7][8][9][12][13][14][15][16][17][18][19][20][21]38,40 Articles referenced but not captured within the original search were used to complement the review and included those which highlight the scale of the problem, 4,7-9 papers which do not relate directly to pre-hospital services 10,[13][14][15][16][17][18]38,40 or seizure management itself 11,19,20 and one article on simple febrile seizures. 21 There is an extensive literature on the management of the seizure patient after arrival in the ED, however, this is beyond the scope of this review.…”

Section: Literature Review Methodsmentioning

confidence: 99%

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines

Osborne

Taylor

Reuber

et al. 2015

Seizure

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The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.

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Section: Literature Review Methodsmentioning

confidence: 99%

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines

Osborne

Taylor

Reuber

et al. 2015

Seizure

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show abstract

“…[1][2][3][4] Several initiatives have demonstrated such reductions may be possible for both adults and children with epilepsy. [5][6][7][8] People with epilepsy at high risk for frequent ED visits are an ideal target group for enrollment in programs to enhance outpatient care, because frequent ED use indicates poor access to care and/or poor disease control.…”

Section: Introductionmentioning

confidence: 99%

Predicting frequent emergency department use among children with epilepsy: A retrospective cohort study using electronic health data from 2 centers

et al. 2017

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SummaryObjective: Among children with epilepsy, to develop and evaluate a model to predict emergency department (ED) use, an indicator of poor disease control and/ or poor access to care. Methods: We used electronic health record data from 2013 to predict ED use in 2014 at 2 centers, benchmarking predictive performance against machine learning algorithms. We evaluated algorithms by calculating the expected yearly ED visits among the 5% highest risk individuals. We estimated the breakeven cost per patient per year for an intervention that reduced ED visits by 10%. We estimated uncertainty via cross-validation and bootstrapping. Results: Bivariate analyses showed multiple potential predictors of ED use (demographics, social determinants of health, comorbidities, insurance, disease severity, and prior health care utilization). A 3-variable model (prior ED use, insurance, number of antiepileptic drugs [AEDs]) performed as well as the best machine learning algorithm at one center (N = 2730; ED visits among top 5% highest risk, 3-variable model, mean = 2.9, interquartile range [IQR] = 2.7-3.1 vs Random Forest, mean = 2.9, IQR = 2.7-3.1), and superior at the second (N = 784; mean = 2.5, IQR = 2.2-2.9 vs mean = 1.9, IQR = 1.6-2.5). The perpatient-per-year breakeven point using this model to identify high-risk individuals was $958 (95% confidence interval [CI] = $568-$1390) at one center and $1086 (95% CI = $886-$1320) at the second. Significance: Prior ED use, insurance status, and number of AEDs, taken together, predict future ED use for children with epilepsy. Our estimates suggest a program targeting high-risk children with epilepsy that reduced ED visits by 10% could spend approximately $1000 per patient per year and break even. Further work is indicated to develop and evaluate such programs. K E Y W O R D Semergency department, epilepsy, health services research, machine learning, pediatrics, predictive modeling

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“…Claims data do not include typically evaluated clinical data on seizure freedom, seizure severity/frequency, and quality of life, as these are dependent upon patient report. Therefore, an approach commonly used in epidemiological studies is the use of surrogate measures available from claims data for these outcomes [7,8]. In fact, some surrogate metrics can better approximate success in the real world as the combination of side effects, dosing, formulary coverage, out-of-pocket costs, administration, and other characteristics of medicines beyond efficacy can be reflected in the stability of treatment and, thus, successful treatment.…”

Section: Introductionmentioning

confidence: 99%

Newer antiepileptic drug use and other factors decreasing hospital encounters

Faught

Helmers

Begley

et al. 2015

Epilepsy & Behavior

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Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization

Abstract: Uncontrolled epilepsy in patients requiring ED visit or hospitalization was associated with significantly greater health care resource utilization and increased direct and indirect costs compared to well-controlled epilepsy in both publicly and privately insured settings.

Cited by 104 publications

References 19 publications

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines

Predicting frequent emergency department use among children with epilepsy: A retrospective cohort study using electronic health data from 2 centers

Newer antiepileptic drug use and other factors decreasing hospital encounters

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