Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study

Abstract

Aims: To quantify the frequency, characteristics, geographical variation and costs of emergency hospital care for suspected seizures.

Design: Cross-sectional study using routinely collected data (Hospital Episode Statistics).

Setting: The National Health Service in England 2007-2013.

Participants: Adults who attended an emergency department (ED) or were admitted to hospital.

Results: In England (population 2011: 53.11 million, 41.77 million adults), suspected seizures gave rise to 50 111 unscheduled admissions per year among adults (≥18 years). This is 47.1% of unscheduled admissions for neurological conditions and 0.71% of all unscheduled admissions. Only a small proportion of admissions for suspected seizures were coded as status epilepticus (3.5%) and there were a very small number of dissociative (non-epileptic) seizures. The median length of stay for each admission was 1 day, the median cost for each admission was £1651 ($2175) and the total cost of all admissions for suspected seizures in England was £88.2 million ($116.2 million) per year. 16.8% of patients had more than one admission per year. There was significant geographical variability in the rate of admissions corrected for population age and gender differences and some areas had rates of admission which were consistently higher than the average.

Conclusions: Our data show that suspected seizures are the most common neurological cause of admissions to hospital in England, that readmissions are common and that there is significant geographical variability in admission rates. This variability has not previously been reported in the published literature. The cause of the geographical variation is unknown; important factors are likely to include prevalence, deprivation and clinical practice and these require further investigation. Dissociative seizures are not adequately diagnosed during ED attendances and hospital admissions.

Keywords: epilepsy; health services; neurology; quality improvement.

Figure 1

Neurological diagnoses ranked by number of emergency hospital admissions between 31 April 2007 and 31 March 2013. Suspected seizures=G40+G41+R56.8.

Figure 2

Kaplan-Meier plots showing the time to first readmission after a suspected seizure when the first admission was for G40+G41+R56.8, G40, G41, R56.8. ICD-10 codes: G40 (epilepsy), G41 (status epilepticus) and R56.8 (other and unspecified convulsions).

Figure 3

Funnel plots showing the directly standardised emergency admission rate per 100 000 of the adult population 2007–2013 in each PCT. (A) G40+G41+R56.8, (B) G40, (C) R56.8. Each dot represents a PCT, the solid line shows the weighted mean for the standardised admission rate, and the dashed and dotted line shows 2 and 3 SD from the mean, respectively. ICD-10 codes: G40 (epilepsy), G41 (status epilepticus) and R56.8 (other and unspecified convulsions). There was not enough data to age–sex standardise the G41 diagnosis code.