Abstract Details

Title Does Discharge Diagnosis Determine Risk of Death? Mortality Following Admission to Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) Epilepsy Monitoring Units (EMUs)

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-009

Objective To evaluate the prognostic significance of discharge diagnosis (i.e. epilepsy, psychogenic non-epileptic seizures [PNES], mixed epileptic and non-epileptic seizures, versus nondiagnostic admissions) on mortality following admission to VHA ECoE EMUs.

Background People with epilepsy and PNES have increased risk of premature mortality compared to the general population.

Design/Methods Retrospective observational cohort study of all Veterans admitted to VHA ECoE EMUs between 10/1/2011 and 9/26/2022 and entered in a national VHA ECoE EMU database. Exclusion criteria included incomplete patient identifiers (21.1% of cohort). Subjects were matched to VHA national administrative data, including date of death. Survival from time of EMU admission was calculated by discharge diagnosis using Kaplan-Meier curves and Cox hazard ratios (HR), and adjusted for age at time of admission, gender and Elixhauser weighted comorbidity index (ECI).

Results Among the 3,930 unique Veterans, 849 (21.6%) died before 2022. Decedents included 276 (31.9%) of 846 Veterans with epilepsy (median age 57 years in EMU, 88.8% male, ECI 11.6); 83 (12.4%) of 672 Veterans with PNES (median 47 years in EMU, 78.3% male, ECI 3.5); 12 (15.2%) of the 79 Veterans with mixed diagnoses (median 50 years in EMU; 79.8% male, ECI 5.7); and 715 (30.9%) of 2,315 Veterans with nondiagnostic admissions (median 57 years in EMU, 58.9% male, ECI 11.3). After adjusting for age, gender and ECI, Veterans with epilepsy had significantly increased risk of premature mortality, compared to Veterans with PNES (HR 1.76, 95% Wald CI 1.04-3.31) and mixed (HR 1.76, 95%CI 1.37-2.25) but not when compared to nondiagnostic admissions (HR 1.07, 95%CI 0.933-1.23).

Conclusions Veterans with epilepsy and nondiagnostic EMU admissions have significantly increased risk of death following discharge, when compared to Veterans with PNES or mixed PNES and epilepsy discharge diagnoses.

Authors/Disclosures
Marissa Kellogg, MD, MPH, FAAN (VA Portland Healthcare System, Dept of Neurology) PRESENTER	The institution of Dr. Kellogg has received research support from VA & DoD.
Megan Amuan	No disclosure on file
Jacqueline Hirschey, MD	Dr. Hirschey has nothing to disclose.
W. C. LaFrance, Jr., MD, MPH, FAAN (Rhode Island Hospital)	Dr. LaFrance has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medico-legal work.. The institution of Dr. LaFrance has received research support from Department of Defense. Dr. LaFrance has received publishing royalties from a publication relating to health care. Dr. LaFrance has received publishing royalties from a publication relating to health care. Dr. LaFrance has a non-compensated relationship as a Steering Committee Member with Xenon that is relevant to AAN interests or activities.
Zulfi Haneef, MD, MBBS, MRCP, FAAN	Dr. Haneef has received publishing royalties from a publication relating to health care.
Hamada H. Altalib, DO (VA Connecticut Healthcare System)	The institution of Dr. Altalib has received research support from UCB. The institution of Dr. Altalib has received research support from DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS.
Rizwana Rehman	No disclosure on file
Mary Jo Pugh, PhD, RN, FAAN	The institution of Dr. Pugh has received research support from Department of Defense, Epilepsy Research Program. The institution of Dr. Pugh has received research support from VA Health Services Research and Development Service. The institution of Dr. Pugh has received research support from VA Rehabilitation Research and Development Service. The institution of Dr. Pugh has received research support from Congressionally Directed Research Programs.

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