To evaluate risk factors for 30-day unplanned readmission in children with epilepsy.

Epilepsy is a common but complex disorder in children, whose costs are driven in part by inpatient hospitalization for seizures. Reduction in readmission rates has been a focus of hospital quality-improvement efforts, but rates and risk factors for epilepsy readmissions are unclear.

We used the Nationwide Readmissions Database years 2013-2014 to conduct a retrospective cohort study of children 1-17 years-old who had the admitting diagnosis epilepsy (ICD9 345.x). The NRD is the only nationally representative data source on hospitalizations/readmissions for all ages and payers, including uninsured patients. The NRD contains data from 22 states, including 51.2% of the U.S. population and 49.3 percent of all U.S hospitalizations. The primary outcome measure was percent readmitted within 30 days. We examined socio-demographic, clinical, and hospital characteristics as predictors of readmission, and report adjusted odds ratios.

We identified 42,873 index admissions chiefly in large(70.3%), metropolitan teaching hospitals (91%). Patients were more often male (54.6%), 4-12 years old (50.8%), and Medicaid participants (61.5%). Status epilepticus occurred in 24.6%, and 20.6% underwent continuous EEG monitoring. The 30-day readmission rate was 10%. Readmission was more likely in children aged 1-3 years than in children aged 4-12 years (AOR 0.84, 95%CI 0.72-0.97) or 13-17 years (AOR 0.75, 95%CI 0.63-0.88). Status epilepticus during index admission was not a risk factor for readmission (AOR 0.9 (0.77-1.06), but comorbid intellectual disability, developmental delay, cerebral palsy, tracheostomy, and gastrostomy each increased the risk of readmission (AOR ranged from 1.17 to 2.04). A diagnosis of intractable epilepsy was also associated with higher readmission rates (AOR 1.53, 95%CI 1.28-1.82).

The burden of unplanned readmissions in pediatric epilepsy may fall on younger children with complex comorbidities. Focusing on this population may improve the effectiveness of future interventions to reduce readmissions.