Abstracts

Rationale: In pediatric patients with refractory epilepsy, decreased seizure burden while on the ketogenic diet anecdotally reduces patients' healthcare utilization, but available data supporting this claim is limited. Our institution has developed and implemented a standardized protocol for inpatient admissions to rapidly and safely initiate the ketogenic diet. This study was done to evaluate the effect of ketogenic diet on healthcare utilization by comparing patient hospitalizations and emergency department visits before and after initiation of the ketogenic diet at our institution.  Methods: A retrospective chart review of all patients initiated on the ketogenic diet and remaining on the diet at least 7 months at our institution from July 1, 2010 through January 31, 2018, was performed. Patients started on the diet for other indications (GLUT-1 deficiency, pyruvate dehydrogenase deficiency), patients under 6 months of age at diet initiation and new emergent starts during hospitalization were excluded. The primary outcome was the number of emergency department visits and hospitalization days during the 6 month time period immediately prior to diet initiation (Baseline, months -6 to 0) and a 6 month time period (Ketogenic diet, months 1 to 7) after ketogenic diet initiation. Results: A total of 74 patients were included in the study. Baseline patient characteristics are listed below in Table 1. Patients starting the ketogenic diet tried a mean (SD) of 5.0 (2.2) antiepileptic drugs prior to starting the ketogenic diet. Healthcare utilization was reduced for the 6 month time period after initiation compared to baseline for both emergency department visits (Baseline 35 visits, Ketogenic diet 21 visits, p=0.3) and total days of hospitalization (Baseline 338 days, Ketogenic 191 days, p=0.18). No difference was seen in total days requiring care in the intensive care unit setting (Baseline 56 days, Ketogenic diet 57 days, p=0.98). A total reduction of inpatient hospitalization of 147 days or 2 days per patient was seen. Table 2 summarizes data around initiation of the ketogenic diet; a total of 252 days for inpatient admission to start the diet and surgical or other procedures was necessary.  Conclusions: The ketogenic diet decreased healthcare utilization during a 6 month time period after initiation compared to the 6 months immediately prior to diet initiation. Funding: No funding