Hospital readmissions in children with new-onset infantile epileptic spasms syndrome
Chellamani Harini1, Christopher J Yuskaitis1, Avantika Singh1
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Infantile epileptic spasms syndrome (IESS) diagnosis leads to significant inpatient resource use, with many patients experiencing frequent readmissions. While some readmissions are preventable, others are linked to complex medical needs.
Area of Science:
- Pediatric Neurology
- Epileptology
- Healthcare Resource Utilization
Background:
- Infantile epileptic spasms syndrome (IESS) is a severe epilepsy syndrome with significant impact on patients and healthcare systems.
- Understanding inpatient resource use and readmission patterns is crucial for optimizing care and reducing healthcare costs.
Purpose of the Study:
- To quantify inpatient resource use within two years of IESS diagnosis.
- To identify clinical and demographic factors associated with readmission incidence and frequency.
- To determine risk factors and reasons for recurrent readmissions in IESS patients.
Main Methods:
- Retrospective cohort analysis of 93 new-onset IESS patients over two years.
- Detailed collection of readmission data (scheduled/unscheduled), length of stay, and clinical/demographic variables.
- Negative binomial and logistic regression analyses to assess factors influencing readmission rates and recurrent readmissions.
Main Results:
- 88% of patients had readmissions, with 40% experiencing ≥5 readmissions.
- Increased readmissions linked to multiple first-line treatments, technology assistance, and multispecialty care; seizure freedom and known etiology were protective.
- Protocol-driven EEG monitoring accounted for 51% of readmissions, decreasing by 52% after protocol modification.
Conclusions:
- Substantial inpatient resource use and high rates of recurrent readmissions are observed in the two years post-IESS diagnosis.
- Readmission drivers include medical complexity and epilepsy-related issues, making preventability uncertain for some.
- Protocol optimization can significantly reduce specific types of readmissions, highlighting areas for intervention.
Objective:
To describe inpatient resource use in the 2 years following infantile epileptic spasms syndrome (IESS) diagnosis, examine the association between clinical/demographic variables and incidence of readmission, and identify risk factors/reasons for frequent readmissions.
Methods:
Retrospective cohort analysis of readmissions (scheduled/unscheduled) within the first 2 years following IESS diagnosis, details of readmissions (number/time between rehospitalizations, and length of stay), demographic/clinical variables, and reasons for readmissions were collected. Negative binomial regression analysis evaluated associations between incidence of readmissions (both scheduled/unscheduled and unscheduled alone) and demographic/clinical factors. Logistic regression assessed the risk of having recurrent readmissions (≥5 readmissions).
Results:
Among 93 (60% males) new-onset IESS patients, there were 394 readmissions (56% scheduled and 44% unscheduled) within 2-years following IESS diagnosis. Mean length of stay was 3.5 days (SD: 5.9). Readmissions occurred in 82 patients (88%) and 37 (40%) experienced ≥5 readmissions. On multivariate regression analysis, readmissions were increased with use of multiple first-line treatments for IESS (P = 0.006), technology assistance (P ≤ 0.001), and multispecialty care (P = 0.01); seizure freedom (P = 0.015) and known etiology (P = 0.011) lowered the incidence of readmissions. Examining unscheduled readmissions separately, increased readmissions occurred with public insurance (P = 0.013), technology use (P ≤ 0.0.001), and multispecialty care (P = 0.013); seizure freedom decreased unscheduled readmissions (P = 0.006). Technology assistance (G-tube, NG tube, VP shunt, and tracheostomy use) increased the odds (P = 0.007) for recurrent readmissions. Reasons for readmissions included EEG monitoring (protocol driven for verification of IESS remission/characterization of events/EEG surveillance/presurgical monitoring) (51%), acute medical issues (21%), and seizure exacerbation (15%). Protocol-driven readmissions declined an estimated 52% following protocol modification during the study.
Significance:
In the 2 years following IESS diagnosis, there is substantial inpatient resource use with nearly 40% experiencing ≥5 readmissions (mostly epilepsy related). Since readmissions are increased by intrinsic patient characteristics such as medical complexity (technology use and multispecialty care) or epilepsy-related issues, the preventability of readmissions is uncertain, except for protocol-driven ones.
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