First seizure clinics: an impactful intervention
Abstract number :
1.425
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2021
Submission ID :
1886412
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Yingtong Li, - Department of Neuroscience, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Zhibin Chen, BSc(Hons) BCom-Accg MBiostat PhD – 1. Department of Neuroscience, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria 3004, Australia; 2. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia; Patrick Kwan, MB BChir FRACP PhD – 1. Department of Neuroscience, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria 3004, Australia; 2. Department of Neurology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Emma Foster, MBBS(Hons) FRACP PhD – 1.Department of Neuroscience, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria 3004, Australia; 2. Department of Neurology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
Rationale: First seizure clinics (FSCs) aim to deliver prompt specialist care to patients with first seizures. Whether this timely intervention translates to better outcomes, and the consequences of failure to attend (FTA) or delayed attendance at FSCs, are largely unexplored.
Methods: We conducted a retrospective cohort study of patients with first seizures identified by the R56.8 ICD-10 code with no previous G40/G41 diagnosis) who attended emergency departments (EDs) between January 2008–December 2017 of two major Melbourne hospitals providing state-wide FSC services. Patients' records were linked to state-wide hospital administrative databases from January 2008 through to June 2018.
We applied multivariable log–binomial generalized linear models to identify clinico-demographic factors associated with FTA. We used zero-inflated negative binomial regression to assess whether FTA influenced subsequent all-cause hospital admission, all-cause ED attendance and seizure-related presentations (either hospital admission or ED attendance). Further, we explored whether time between FSC referral and FSC attendance influenced those subsequent outcomes.
Results: 4903 first seizure patients presented to the study hospital EDs during the study period, and 30% (n = 1458) were referred to FSC. 58% (n = 840) attended with a median delay of 44 days (IQR 18–91) between referral and attendance. 22% (n = 324) canceled or rescheduled, and 20% (n = 294) failed to attend without notice. Linkage data following the first seizure ED presentation was available for a median of 4.3 years (IQR 2.3–6.2) for those who attended FSC and 4.4 years (IQR 2.4–6.8) for those who were referred but failed to attend (p = 0.2).
Clinico-demographic factors associated with increased risk of FTA were younger age (relative risk [RR] 2.48, 95% CI: 1.70–3.63; p= 0.001) and greater relative socioeconomic advantage (RR 1.47, 95% CI: 1.08–2.01; p = 0.02) (Figure 1).
FTA was significantly associated with increased subsequent all-cause hospital admission (incidence rate ratio [IRR] 2.69, 95% CI: 2.06–3.50; p < 0.001), subsequent all-cause ED attendance (IRR 2.66, 95% CI: 2.05–3.44; p < 0.001), and subsequent seizure-related presentations (IRR 2.34, 95% CI: 1.63–3.37; p < 0.001) (Figure 2).
Delayed FSC attendance was similarly associated with significantly increased subsequent all-cause hospital admissions (IRR 1.07 per month of delay, 95% CI: 1.05–1.08; p < 0.001), all-cause ED attendances (IRR 1.05 per month, 95% CI: 1.03–1.06; p < 0.001), and seizure-related presentations (IRR 1.03 per month, 95% CI: 1.03–1.04; p < 0.001).
Health Services (Delivery of Care, Access to Care, Health Care Models)