Predictors of follow-up care for critically-ill patients with seizures and epileptiform abnormalities on EEG monitoring

Clin Neurol Neurosurg. 2024 Jun:241:108275. doi: 10.1016/j.clineuro.2024.108275. Epub 2024 Apr 6.

Abstract

Objective: Post-hospitalization follow-up visits are crucial for preventing long-term complications. Patients with electrographic epileptiform abnormalities (EA) including seizures and periodic and rhythmic patterns are especially in need of follow-up for long-term seizure risk stratification and medication management. We sought to identify predictors of follow-up.

Methods: This is a retrospective cohort study of all patients (age ≥ 18 years) admitted to intensive care units that underwent continuous EEG (cEEG) monitoring at a single center between 01/2016-12/2019. Patients with EAs were included. Clinical and demographic variables were recorded. Follow-up status was determined using visit records 6-month post discharge, and visits were stratified as outpatient follow-up, neurology follow-up, and inpatient readmission. Lasso feature selection analysis was performed.

Results: 723 patients (53 % female, mean (std) age of 62.3 (16.4) years) were identified from cEEG records with 575 (79 %) surviving to discharge. Of those discharged, 450 (78 %) had outpatient follow-up, 316 (55 %) had a neurology follow-up, and 288 (50 %) were readmitted during the 6-month period. Discharge on antiseizure medications (ASM), younger age, admission to neurosurgery, and proximity to the hospital were predictors of neurology follow-up visits. Discharge on ASMs, along with longer length of stay, younger age, emergency admissions, and higher illness severity were predictors of readmission.

Significance: ASMs at discharge, demographics (age, address), hospital care teams, and illness severity determine probability of follow-up. Parameters identified in this study may help healthcare systems develop interventions to improve care transitions for critically-ill patients with seizures and other EA.

Keywords: Anti-seizure medication(s); Critical care; Electroencephalogram (EEG); Follow-up(s); Readmission; Seizure(s).

MeSH terms

  • Adult
  • Aftercare
  • Aged
  • Anticonvulsants / therapeutic use
  • Cohort Studies
  • Critical Illness* / therapy
  • Electroencephalography* / methods
  • Epilepsy / diagnosis
  • Epilepsy / physiopathology
  • Epilepsy / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Retrospective Studies
  • Seizures* / diagnosis
  • Seizures* / physiopathology
  • Seizures* / therapy