Healthcare utilization in drug-resistant epilepsy: A retrospective cohort study into factors predictive of success during short pediatric EMU admissions.

objectiveThe Epilepsy Monitoring Unit (EMU) plays a crucial role in a patient's diagnosis and management of seizures and epilepsy. This is a resource-intensive test; therefore, it is beneficial to be able to predict which patients may need a short admission and which patients may require repeated admissions. The duration of stay required to obtain adequate information is not clear, especially in the pediatric population. In this study, we examine factors that predict success during a short admission and those that predict the need for repeat admissions.

methodsRetrospective review of 462 admissions (2014-2024). We included any patient admitted to CHEO's EMU for four or fewer days.

resultsThe median (IQR) admission was 2 (1, 2) days. 23.6% (95% CI: 19.9%, 27.7%) of EMU visits were repeat admissions. 82.0% (95% CI: 78.3%, 85.3%) of admissions were successful. A diagnosis of drug-resistant epilepsy is associated with a higher chance of achieving admission goals (OR = 2.2, 95% CI 1.3, 3.7, p = 0.002). Through a binary logistic regression, we show that a previous diagnosis of drug-resistant epilepsy increases the chance of repeat admission to the EMU (odds ratio = 4.2, 95% CI 2.4, 7.6, p < 0.001), when adjusting for seizure type, admission goals, weaning of meds, age, and gender. Seizure type (focal, generalized, or both) has no influence on the likelihood of repeat admission or achieving admission goals. SIGNIFICANCE: Having a pediatric EMU monitoring period of 1-4 days was sufficient to achieve admission goals in over 80% of patients in this cohort, suggesting that many pediatric patients can have their EMU goals achieve during short stays. Patients with drug-resistant epilepsy are more likely to have a successful initial admission, but also to require repeat admissions. These results can be used to better plan for resource utilization in a pediatric EMU.