Abstracts

Rationale: Video-EEG monitoring is a useful tool in different clinical settings, including diagnosis of unclear clinical paroxysmal events, seizure classification, and pre-surgical evaluation. Incorrect diagnosis, inappropriate treatment and intractable epilepsy can lead to unnecessary or higher cost of care and poor outcomes. There is no large database study available to compare the outcomes and cost related to video-EEG monitoring in hospitalized patients. Our aim was to find out the trend, cost, and outcomes related to video-EEG utilization amongst patients hospitalized with epilepsy Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample (NIS) (years 2000-2013) in adult hospitalizations for generalized and focal epilepsy to determine the outcomes (mortality, APRDRG risk of death, and discharge disposition) and utilization of Video-EEG monitoring using ICD-9-CM codes. We performed weighted analyses using student t-test, Chi-Square test, and Cochran-Armitage trend test. Results: During years 2000 to 2013, of the total 358,401 epilepsy hospitalizations, 219,791 patients had a diagnosis of generalized epilepsy and 142,666 presented with focal epilepsy (includes 4056 patients with both types of epilepsy). Video-EEG monitoring was done in 76,326 (21.3%) patients. Trend of video-EEG monitoring utilization among total epilepsy hospitalizations had significantly increased from 16.9% in 2000 to 24.04% in 2013 (p < 0.001) [For Generalized epilepsy hospitalizations: 9.59% in 2000 to 15.46% in 2013 (p < 0.001); and for Focal epilepsy hospitalizations: 31.2% in 2000 to 36.50% in 2013 (p < 0.001)]. Utilization of Video-EEG monitoring was associated with lower frequencies of all causes of in hospital mortality (0.08% vs. 0.54%; p < 0.001), extreme likelihood of death (2.90% vs. 13.31%; p < 0.001), transferred to short-term hospital/skilled nursing facility/intermediate care/long term care facility (5.69% vs. 21.18%; p < 0.001), and poor outcomes (combined death or loss of function or transfer other than home/routine) (7.13% vs. 26.65%; p < 0.001). Among Video-EEG monitored patients 94.31% patients were discharged to home in comparison to non V-EEG monitored patients (78.82%) (p < 0.0001). Mean cost of hospitalization with video-EEG monitoring was $7141 higher in comparison to non-monitored patients ($32,556 vs. $25,414; p < 0.0001). Conclusions: Video-EEG monitoring is associated with better outcomes among hospitalized epilepsy patients. It also increases discharges to home with no requirement for home health care services among hospitalized epilepsy patients. It does have a higher cost of care but this cost does seem justified based on the better outcomes and significantly better rates of discharges to home. Funding: None