Seizure frequency, healthcare resource utilisation and mortality in childhood epilepsy: a retrospective cohort study using the THIN database

Arch Dis Child. 2019 Nov;104(11):1070-1076. doi: 10.1136/archdischild-2019-316910. Epub 2019 Jul 4.


Objective: To understand the association of seizure frequency with healthcare resource utilisation (HCRU) and mortality in UK children with epilepsy (CWE).

Design: Retrospective cohort study.

Setting: Routinely collected data in primary care from The Health Improvement Network UK database.

Patients: CWE ≥1 and<18 years of age with a record of seizure frequency were included in mortality analyses from 2005 to 2015 and HCRU analyses from 2010 to 2015.

Main outcome measures: Frequency of HCRU contacts during the year following latest seizure frequency and mortality (descriptive and Cox proportional hazards regression) from first record of seizure frequency.

Results: Higher seizure frequency was related to increased HCRU utilisation and mortality. In negative binomial regression, each category increase in seizure frequency related to 11% more visits to general practitioners, 35% more inpatient admissions, 15% more outpatient visits and increased direct HCRU costs (24%). 11 patients died during 12 490 patient-years follow-up. The unadjusted HR of mortality per higher category of seizure frequency was 2.56 (95% CI: 1.52 to 4.31). Adjustment for age and number of prescribed anti-epileptic drugs at index attenuated this estimate to 2.11 (95% CI: 1.24 to 3.60).

Conclusion: Higher seizure frequency is associated with greater HCRU and mortality in CWE in the UK. Improvement in seizure control may potentially lead to better patient outcomes and reduced healthcare use.

Keywords: epidemiology; neurology; paediatric practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Databases, Factual
  • Epilepsy / epidemiology*
  • Epilepsy / mortality
  • Epilepsy / physiopathology
  • Female
  • Humans
  • Infant
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Retrospective Studies
  • Seizures / epidemiology*
  • Seizures / mortality
  • Seizures / physiopathology
  • Severity of Illness Index
  • United Kingdom / epidemiology