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Abstract Details

Access to Inpatient Video-EEG Monitoring for Patients with Frequent Seizure-Related Emergency Visits
Epilepsy/Clinical Neurophysiology (EEG)
P4 - Poster Session 4 (5:00 PM-6:00 PM)
9-001
The objective is to characterize barriers and facilitators to receiving video-EEG monitoring (VEEG) among patients with frequent seizure-related emergency department (ED) visits.
Seizure characterization with VEEG is a critical service for people with drug-resistant epilepsy that guides management decisions. However, racial/ethnic and socioeconomic disparities continue to prevent equitable access to epilepsy care in the US. We hypothesized that minoritized race/ethnicity, insurance barriers, and low socioeconomic status were associated with decreased access to VEEG among patients with frequent seizure-related ED visits.
This was a retrospective cohort study of patients with frequent ED visits (>2) for seizure/epilepsy in four US states (Florida, Maryland, New York, and Wisconsin) between 12/1/2016 and 12/31/2018. We identified patients who underwent inpatient VEEG during the study period. We performed a multivariable logistic regression analysis evaluating receipt of VEEG with race/ethnicity, insurance payer, and median income by zip code.

Of the 28,598 frequent ED visit cohort, 1131 (3.95%) received VEEG. No significant association was seen with any racial/ethnic group compared with White patients. Men were less likely to undergo VEEG than women (adjusted odds ratio [aOR] 0.78, 95% confidence interval[CI]: 0.69-0.88). Patients with Medicare (aOR 0.86, 95%CI: 0.71-1.05), Medicaid (aOR 0.64, 95%CI: 0.54-0.76), and no insurance (aOR 0.38, CI: 0.27-0.52) were less likely to receive VEEG compared to those with private insurance. Those living in the lowest income quartile by zip code were also less likely to undergo VEEG (aOR 0.71, 95%CI: 0.57-0.87, versus the top quartile). Living in a county with an accredited epilepsy center increased the likelihood of VEEG (aOR 1.55, 95%CI: 1.21-2.00).

While we did not identify any racial/ethnic disparities in this cohort, insurance and socioeconomic factors represent significant barriers in accessing VEEG. Future efforts should focus on referring patients to the level of neurological care they need, rather than what they can afford.
Authors/Disclosures
Casey Kozak
PRESENTER 		Ms. Kozak has nothing to disclose.
Khushi Patel, BA Ms. Patel has nothing to disclose.
Nikita Jadav, Medical Student Miss Jadav has nothing to disclose.
Aarushi Parikh, MA Ms. Parikh has nothing to disclose.
Kylie Getz Kylie Getz has nothing to disclose.
Brad K. Kamitaki, MD (Rutgers-Robert Wood Johnson Medical School) Dr. Kamitaki has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Brown and Brown Absence Services Group. The institution of Dr. Kamitaki has received research support from New Jersey Health Foundation. The institution of Dr. Kamitaki has received research support from National Institute on Aging.