Emergency department visits and readmissions in patients with psychogenic nonepileptic seizures (PNES) at a safety net hospital

Ramamurthy, Swetha; Brown, L. Steven; Agostini, Mark; Lindstorm, Sasha Alick; Dave, Hina; Dieppa, Marisara; Ding, Kan; Doyle, Alexander; Hays, Ryan; Harvey, Jay; Podkorytova, Irina; Zepeda, Rodrigo; Das, Rohit R.

doi:10.1016/j.yebeh.2021.108225

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…Four other studies reported a prevalence of homelessness among PWE between 1.8 and 4% (Rimmer et al 2007 ; Gabriel et al 2020 ; Ramamurthy et al 2021 ; Lennard et al 2022 ).…”

Section: Resultsmentioning

confidence: 97%

“…Epilepsy also accounts for a big portion of health care costs and overall disease burden both for individuals and health services (WHO 2022 ). Homeless people living with epilepsy presented worse institutional quality measures such as hospital admissions, occupied hospital beds and unplanned readmissions, leading to worst outcomes for health centers globally (Ramamurthy et al 2021 ). These people are being inappropriately managed in ED for ACSC, causing sub-optimal disease control, higher risk of future exacerbations and more economic burden for hospitals, as this is not a cost-effective strategy (Doran et al 2021a , b ).…”

Section: Discussionmentioning

confidence: 99%

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The homeless, seizures, and epilepsy: a review

Pontes Silva,

Gama Marques

2023

J Neural Transm

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This review aims to estimate the prevalence of seizures and epilepsy among homeless people in current literature as well as understand the main adversities that this group withstands. We conducted a search for “epilep*”, “seizur*”, and “homeles*” in titles and abstracts of articles in PubMed. Overall, 25 articles met the final inclusion criteria and warranted analyses. This study suggests that the prevalence of epilepsy in the homeless population is between 2 and 30%, whereas the prevalence of homelessness in people with epilepsy is between 2 and 4%. Every study included in this review corroborates the increased prevalence of seizures and epilepsy among the homeless, which puts them at risk for worse outcomes related to this condition and numerous associated comorbidities. Further evidence is needed to clarify the distinction of primary and secondary seizures in this group, which shows a high rate of confounding factors for seizures like substance abuse or withdrawal and head injury, and to decrease the burden of epilepsy and homelessness in an already resource-deficient community.

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“…Four other studies reported a prevalence of homelessness among PWE between 1.8 and 4% (Rimmer et al 2007 ; Gabriel et al 2020 ; Ramamurthy et al 2021 ; Lennard et al 2022 ).…”

Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

The homeless, seizures, and epilepsy: a review

Pontes Silva,

Gama Marques

2023

J Neural Transm

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“…Anderson et al ( 39 ) found a significant reduction of 92% in the total average contacts (included emergency department visits, hospital admissions, outpatient clinic appointments, and brain imaging) in 24 patients diagnosed with PNES alone. Conversely, Ramamurthy et al ( 40 ) found that 23% visited the emergency department a month after PNES diagnosis, and Salinsky et al ( 41 ) found no overall improvement in health care utilization during the 3 years following PNES diagnosis compared to 3 years before diagnosis. Another promising finding was the significant increase in employment rate; the number of patients working actually doubled after the PNES diagnosis (49 vs. 25%), and only 16 out of 43 patients (37%) who had a job were unable to return to work; this rate is lower than what has been reported previously showing a range of 43–89% ( 25 ) of patients with PNES unable to regain their professional lives.…”

Section: Discussionmentioning

confidence: 99%

Outcome of psychogenic non-epileptic seizures following diagnosis in the epilepsy monitoring unit

Abi-Nahed,

Li,

Carlier

et al. 2024

Front. Neurol.

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ObjectiveTo study the outcome of patients with psychogenic non-epileptic seizures (PNES) after their diagnosis in the epilepsy monitoring unit (EMU).MethodsPatients diagnosed in our EMU with definite PNES between January 2009 and May 2023 were contacted by phone, and those who agreed to participate were asked a set of predetermined questions. Comparative analyses were carried out on several variables before and after diagnosis: number of participants with daily PNES, number of visits to the emergency department, number of participants who consulted their general practitioner or a neurologist outside of a scheduled follow-up, number of participants who took antiseizure medications (ASMs) or psychotropic drugs, and employment status.ResultsOut of the 103 patients with a definite diagnosis of PNES, 61 patients (79% female) accepted to participate in our study. The median age at PNES onset was 35 years, and the median delay to diagnosis was 3 years. Almost two-thirds (62%) were receiving ASMs and 40% psychotropic drugs. The mean stay at the EMU was 5 days. PNES diagnosis was explained to almost all patients (97%) by the end of their EMU stay and was well-accepted by most (89%). When contacted, 46% of participants no longer had PNES; 32% mentioned that their PNES had ceased immediately upon communication of the diagnosis. The median follow-up duration was 51 months. Fewer patients had daily seizures after the diagnosis (18 vs. 38%; p < 0.0455). Similarly, the median number of emergency department visits was significantly lower (0 vs. 2; p < 0.001). Only 17 patients consulted their general practitioner (vs. 40, p < 0.001) and 20 a neurologist (vs. 55, p < 0.001) after a PNES attack outside of a scheduled follow-up. The use of ASMs was also significantly reduced from 70 to 33% (p < 0.01), with only one still taking an ASM for its antiseizure properties. Significantly more participants were working at last follow-up than at PNES diagnosis (49 vs. 25%; p < 0.001).ConclusionOur study revealed a relatively favorable long-term outcome of definite PNES diagnosed in the EMU that translated in significant reductions in PNES frequency, health care utilization and ASM use, as well as a significant increase in employment rate.

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“…To date, few studies have explored health care utilization in the epilepsy population in both the ED and inpatient settings together. 5 Most studies exploring frequent ED use among seizure and epilepsy patients have been limited in size and scope, focusing on individual health systems or specific patient subpopulations with elevated ED utilization, such as those with severe childhood onset epilepsies. [6][7][8][9] Literature on utilization of inpatient care has primarily focused on 30-day readmissions, [10][11][12] which have traditionally served as a key metric of health care utilization and potentially preventable costs.…”

Section: Introductionmentioning

confidence: 99%

“…To date, few studies have explored health care utilization in the epilepsy population in both the ED and inpatient settings together 5 . Most studies exploring frequent ED use among seizure and epilepsy patients have been limited in size and scope, focusing on individual health systems or specific patient subpopulations with elevated ED utilization, such as those with severe childhood onset epilepsies 6–9 .…”

Section: Introductionmentioning

confidence: 99%

Characterizing emergency department and inpatient health care utilization after seizure‐related hospitalization: A retrospective cohort study

Johnson,

Wood,

Hsia

et al. 2024

Epilepsia

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ObjectiveSeizure care is a significant driver of health care costs in both emergency department (ED) and inpatient settings, but the majority of studies have focused on inpatient admissions as the only metric of health care utilization. This study aims to better characterize ED and inpatient encounters among patients with seizure to inform care and policy.MethodsUsing statewide administrative data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from Florida and New York, we identified patients with a seizure‐related index hospitalization between January 1, 2016, and December 31, 2018. Among this cohort, we examined the incidence and characteristics of subsequent acute care visits in the ED and inpatient settings for 365 days after initial hospital discharge.ResultsA total of 54 456 patients had an eligible seizure‐related hospitalization. Patients were 49% female, predominantly White (64%) and non‐Hispanic (84%), and used a public primary payer (68%). There were 36 838 (68%) patients with at least one acute care visit in the year following discharge. Overall, patients had a median of 2 (interquartile [IQR] = 1–5) subsequent acute care visits and the median time to first acute care visit was 53 days (IQR = 15–138). Of the 154 369 subsequent acute care visits, 97 399 (63%) were ED‐only visits, 56 970 (37%) were readmissions, and 37 176 (24%) were seizure‐related. There were 18 786 patients (35%) with four or more acute care visits over 365 days of follow‐up. Patients with four or more visits contributed 84% of acute care visits and 78% of costs after initial hospitalization.SignificanceThe majority of patients hospitalized for seizure return to the ED or hospital at least once in the year after discharge. A small portion of patients account for the majority of ED and inpatient visits as well as health care costs associated with this population, identifying a subgroup of patients who may benefit from improved inpatient and outpatient management.

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Emergency department visits and readmissions in patients with psychogenic nonepileptic seizures (PNES) at a safety net hospital

Cited by 7 publications

References 24 publications

The homeless, seizures, and epilepsy: a review

The homeless, seizures, and epilepsy: a review

Outcome of psychogenic non-epileptic seizures following diagnosis in the epilepsy monitoring unit

Characterizing emergency department and inpatient health care utilization after seizure‐related hospitalization: A retrospective cohort study

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