Evidence map›Paper›PMID 39971602›Full record

Observational studyBMJ open2025

Is geographical variation in emergency epilepsy admissions related to variation in new epilepsy diagnoses among children and young people across England? An observational study using linked datasets.

Rakhee Shah, Sandeepa Arora, Colin Dunkley, Niky Raja, Alex Bottle, Dougal S Hargreaves

Abstract readObservational Study
In one paragraph

Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Rakhee ShahMohn Centre for Children's Health and Wellbeing, Department of Epidemiology and Biostatistics, Imperial College London, London, UK rakhee.shah@imperial.ac.uk.ORCID 0000-0001-9063-5744
Sandeepa AroraMohn Centre for Children's Health and Wellbeing, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Colin DunkleySherwood Forest Hospitals Foundation Trust, Sutton in Ashfield, UK.
Niky RajaRoyal College of Paediatrics and Child Health, London, UK.
Alex BottleDepartment of Primary Care and Public Health, Imperial College London, London, UK.ORCID 0000-0001-9978-2011
Dougal S HargreavesMohn Centre for Children's Health and Wellbeing, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.ORCID 0000-0003-0722-9847

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPrevious studies have reported widespread unexplained geographical variations in emergency paediatric admissions for epilepsy.

objectivesOur aim was to investigate the extent to which geographical variation in epilepsy admissions among children and young people (CYP) aged 0-18 years, in England, reflects variation in new epilepsy diagnoses. DESIGN AND

settingA retrospective secondary analysis of Hospital Episode Statistics data for emergency admissions between April 2018 and March 2019, and Epilepsy12 audit data for new epilepsy diagnoses in England, between July and November 2018. OUTCOME MEASURES: The ratios of observed to expected epilepsy admissions and new diagnoses were calculated for each hospital Trust, based on their catchment population, and adjusted for age, sex and deprivation. Standardised ratios of observed to expected epilepsy admissions were plotted against standardised ratios of observed to expected new diagnoses of epilepsy at Trust level and the Pearson correlation coefficient was calculated.

resultsThere were 9246 emergency admissions for CYP to 134 Trusts with a primary diagnosis of epilepsy in England during the study period. 60 Trusts (44.4%) had either significantly lower or higher than expected standardised admission ratios for a primary diagnosis of epilepsy. There were 960 new diagnoses of epilepsy between July and November 2018 for 74 Trusts. 14 Trusts (18.9%) had either lower or higher standardised diagnosis ratios for a new diagnosis of epilepsy. There was no correlation between standardised emergency epilepsy admissions ratios and standardised new epilepsy diagnoses ratios at Trust level (Pearson r -0.06, p 0.63).

conclusionsWidespread unexplained variation in epilepsy admissions cannot be explained by variation in new epilepsy diagnosis. This raises concerns about the equity and accessibility of epilepsy services. Unit-level benchmarking data on new diagnoses and admissions for epilepsy can inform strategies to improve access to care and health outcomes.

Indexed as

Emergency Service, HospitalEpilepsyHospitalizationPatient AdmissionAdolescentChildChild, PreschoolEnglandFemaleHumansInfantInfant, NewbornMaleRetrospective StudiesEpilepsyHealth Services AccessibilityPaediatric neurology

Identifiers

PMID39971602
PMCPMC11840900

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.