Analysing Regional Variation in Referrals to the Children's Epilepsy Surgery Service: A Novel Methodology

It is unclear whether the underutilisation of the UK Children's Epilepsy Surgery Service (CESS) can be attributed to regional referral differences. This study develops a mapping tool to visualise CESS referrals, identifying any regional disparities and exploring the relationship between referrals and deprivation. Mapping posterior urethral valve (PUV) surgery referrals demonstrates the utility of this model for other health conditions.

Accepted CESS referrals within the catchment area of one centre between April 2017 and March 2022 were recorded in the Orion registry (n = 291). PUV referrals to one tertiary centre in the same region, between January 2013 and June 2023, were mapped using the same model (n = 212).

Referral incidences per integrated care board (ICB) were calculated and visualised with choropleth maps. Pearson's correlation coefficient identified any relationship between referral incidence and population-weighted ICB deprivation scores. CESS referral incidence ranged from 30.06 to 39.9 per million under-18s. PUV referral incidence ranged from 12.0 to 46.9 per million under-18 males, yielding a statistically significant difference in variability between the two groups (p = 0.04). Referral incidence was independent of deprivation (p = 0.29 and p = 0.13, respectively).

There is equity in CESS referrals within the region. The mapping tool is widely applicable, providing visually representable referral data without being patient-identifiable.