Readmission and emergency department presentation after hospitalisation for epilepsy in people with intellectual disability: A data linkage study

Abstract

Background Despite the high prevalence of epilepsy and multiple barriers to care in people with intellectual disability, the risk of returning to hospital after an admission for epilepsy is largely unknown. In this study, we sought to quantify and compare readmission and emergency department (ED) presentations after hospitalisation for epilepsy in people with and without intellectual disability. Methods and findings Using linked administrative datasets, we conducted a retrospective cohort study of people aged 5–64 years with an acute hospitalisation for epilepsy from 2005–2014 in New South Wales, Australia. Acute readmission and ED presentation rates within 30, 90, and 365 days of the index hospitalisation were estimated and compared between people with and without intellectual disability using modified Poisson regression. Of 13537 individuals with an index hospitalisation, 712 children and 1862 adults had intellectual disability. Readmission and ED presentation after the index hospitalisation were common in people with intellectual disability. Within 30 days, 11% of children and 15.6% of adults had an all-cause readmission and 18% of children and 23.5% of adults had an ED presentation. Over 60% of both children and adults presented to an ED within a year. Neurological, respiratory, and infectious conditions were overrepresented reasons for readmission in people with intellectual disability. Age-adjusted relative risks (RRs) within each period showed a higher risk of readmission and ED presentation in children and adults with intellectual disability than without. Most RRs remained statistically significant after controlling for covariates. The largest adjusted RRs were observed for readmission for epilepsy (RR 1.70, 95% CI: 1.42 to 2.04) and non-epilepsy related conditions (RR 1.73, 95%: CI 1.43 to 2.10) in children. Study limitations include lack of clinical data. Conclusions Increased risk of returning to acute care after epilepsy hospitalisation suggests there is a need to improve epilepsy care for people with intellectual disability. We recommend research into strategies to improve management of both seizures and comorbidity.

Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability

“…The effect of intentional self-harm on readmission risk observed in people with epilepsy and ID may be explained by many factors, including underlying psychiatric conditions. While a high risk of self-harm may have contributed to more readmissions (Owens et al 2002), the evidence indicates that self-harm likely accounted for less than 9% of readmissions and even fewer in children (Liao et al 2022). Our finding emphasises the need for more research to improve recognition and potentially also the management of intentional self-harm in people with ID and epilepsy.…”

“…People with more severe and refractory epilepsy could have more readmissions for epilepsy. Epilepsy is the leading reason for readmission within both 30 and 365 days after hospitalisation for epilepsy in both children and adults with ID (Liao et al 2022), and other prevalent reasons include respiratory, mental and infectious diseases and injuries. Among the broader population of people with ID (including individuals both with and without epilepsy), research has also repeatedly observed the association of greater comorbidity burden with more frequent hospitalisation or re-hospitalisation (Balogh et al 2013;Sheehan et al 2020).…”

“… 2002 ), the evidence indicates that self‐harm likely accounted for less than 9% of readmissions and even fewer in children (Liao et al . 2022 ). Our finding emphasises the need for more research to improve recognition and potentially also the management of intentional self‐harm in people with ID and epilepsy.…”

Hub and spokes in intellectual disability mental health support

“…Previous research indicates substantially higher costs of mental health care for people with intellectual disability, and inefficiency of this care through frequent re-presentations to acute care services after discharge'. 28 Increased efficiencies in Elrod and Fortenberry's framework are gained through the centralization of specialist technologies, skills and services at the hub. Centralization increases efficiencies by eliminating duplication of services, offering increased return on investment and bolstering economies of scale.…”