Characteristics of people with epilepsy who attend emergency departments: Prospective study of metropolitan hospital attendees

Noble, Adam; Goldstein, Laura H.; Seed, Paul; Glucksman, E; Ridsdale, Leone

doi:10.1111/j.1528-1167.2012.03586.x

Cited by 63 publications

(75 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…6 Those who repeatedly attend EDs report poorer Quality of Life (QoL), increased stigmatisation and higher levels of anxiety and depression. 7 ED visits and subsequent hospitalisations contribute to the majority of the economic burden of uncontrolled epilepsy 8 with previous authors recently estimating an annual cost of s417,074 (£347,544) per 100,000 per year for hospital admissions alone. 9 In this paper we initially present a summary of the current official UK guidance for the pre-hospital management of seizures by ambulance clinicians.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Osborne

Taylor

Reuber

et al. 2015

Seizure

View full text Add to dashboard Cite

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.

show abstract

Section: Literature Review Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Osborne

Taylor

Reuber

et al. 2015

Seizure

View full text Add to dashboard Cite

show abstract

“…[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. [9][10][11][12] Quantifying "high risk" in this context is an active area of research. 13 Prior work using data from multiple hospitals found that future frequent ED use could be accurately predicted solely by examining prior ED use, despite the availability of additional demographics and comorbidity data.…”

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

View full text Add to dashboard Cite

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

show abstract

“…10 For people with epilepsy, several factors are associated with frequent ED use: low socioeconomic status, more seizures, anxiety, poor knowledge of epilepsy by self or caregivers, and greater stigma. [11][12][13] However, the predictability of frequent ED use is understudied. Studying frequent ED use is challenging, in part because people often use multiple EDs for care.…”

mentioning

confidence: 99%

Predicting frequent ED use by people with epilepsy with health information exchange data

et al. 2015

View full text Add to dashboard Cite

Objectives: To describe (1) the predictability of frequent emergency department (ED) use (a marker of inadequate disease control and/or poor access to care), and (2) the demographics, comorbidities, and use of health services of frequent ED users, among people with epilepsy. Methods:We obtained demographics, comorbidities, and 2 years of encounter data for 8,041people with epilepsy from a health information exchange in New York City. Using a retrospective cohort design, we explored bivariate relationships between baseline characteristics (year 1) and subsequent frequent ED use (year 2). We then built, evaluated, and compared predictive models to identify frequent ED users ($4 visits year 2), using multiple techniques (logistic regression, lasso, elastic net, CART [classification and regression trees], Random Forests, AdaBoost, support vector machines). We selected a final model based on performance and simplicity.Results: People with epilepsy who, in year 1, were adults (rather than children or seniors), male, Manhattan residents, frequent users of health services, users of multiple health systems, or had medical, neurologic, or psychiatric comorbidities, were more likely to frequently use the ED in year 2. Predictive techniques identified frequent ED visitors with good positive predictive value (approximately 70%) but poor sensitivity (approximately 20%). A simple strategy, selecting individuals with 111 ED visits in year 1, performed as well as more sophisticated models. Epilepsy is an ambulatory care sensitive condition; that is, high quality outpatient care may reduce unnecessary inpatient and emergency department (ED) care. Conclusions:1-5 Thus, frequent ED use is a "health services marker," indicating inadequate disease control and/or poor access to care. 6 Health care organizations in the United States, encouraged by recent state and federal policy changes, frequently hire care managers to coordinate care for people with ambulatory care sensitive conditions such as epilepsy.7-9 One common strategy is to focus on patients at high risk of frequent ED use.10 For people with epilepsy, several factors are associated with frequent ED use: low socioeconomic status, more seizures, anxiety, poor knowledge of epilepsy by self or caregivers, and greater stigma.11-13 However, the predictability of frequent ED use is understudied. Studying frequent ED use is challenging, in part because people often use multiple EDs for care.14,15 Health information exchange (HIE) networks allow users to view medical information in the electronic health records of multiple unaffiliated institutions, creating a more complete record than possible from a single center's data.14 These technologies are increasingly available, 16,17 and may provide a data source to describe and predict frequent ED use.From the

show abstract

Characteristics of people with epilepsy who attend emergency departments: Prospective study of metropolitan hospital attendees

Cited by 63 publications

References 55 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

Predicting frequent ED use by people with epilepsy with health information exchange data

Contact Info

Product

Resources

About