Predictors of follow-up care for critically-ill patients with seizures and epileptiform abnormalities on EEG monitoring.

Objective: Post-hospitalization follow-up visits are crucial for preventing long-term complications. Patients with electrographic epileptiform abnormalities (EA) including seizures and periodic and rhythmic patterns are especially in need of follow-up for long-term seizure risk stratification and medication management. We sought to identify predictors of follow-up.
Methods: This is a retrospective cohort study of all patients (age ≥ 18 years) admitted to intensive care units that underwent continuous EEG (cEEG) monitoring at a single center between 01/2016-12/2019. Patients with EAs were included. Clinical and demographic variables were recorded. Follow-up status was determined using visit records 6-month post discharge, and visits were stratified as outpatient follow-up, neurology follow-up, and inpatient readmission. Lasso feature selection analysis was performed.
Results: 723 patients (53 % female, mean (std) age of 62.3 (16.4) years) were identified from cEEG records with 575 (79 %) surviving to discharge. Of those discharged, 450 (78 %) had outpatient follow-up, 316 (55 %) had a neurology follow-up, and 288 (50 %) were readmitted during the 6-month period. Discharge on antiseizure medications (ASM), younger age, admission to neurosurgery, and proximity to the hospital were predictors of neurology follow-up visits. Discharge on ASMs, along with longer length of stay, younger age, emergency admissions, and higher illness severity were predictors of readmission.
Significance: ASMs at discharge, demographics (age, address), hospital care teams, and illness severity determine probability of follow-up. Parameters identified in this study may help healthcare systems develop interventions to improve care transitions for critically-ill patients with seizures and other EA.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sahar F. Zafar, MD reports financial support was provided by National Institute of Health. Sahar F. Zafar, MD reports financial support was provided by American Epilepsy Society. Sahar F Zafar MD reports a relationship with CortiCare Inc that includes: clinical consulting. Sahar F. Zafar MD reports a relationship with Marinus Pharmaceuticals Inc that includes: speaking and lecture fees. Clio Rubinos MD MS reports a relationship with American Epilepsy Society that includes: speaking and lecture fees. Clio Rubinos MD MS reports a relationship with Marinus Pharmaceuticals Inc that includes: speaking and lecture fees. Clio Rubinos MD MS reports a relationship with Azurity Pharmaceuticals Inc that includes: board membership and consulting or advisory. Adithya Sivaraju MD reports a relationship with Swebilius Foundation that includes: funding grants. Adithya Sivaraju MD reports a relationship with American Epilepsy Society that includes: funding grants. Vineet Punia MD MS reports a relationship with Catalyst Pharmaceuticals Inc that includes: board membership and consulting or advisory. Vineet Punia MD MS reports a relationship with Ovid Therapeutics Inc that includes: board membership and consulting or advisory. Vineet Punia MD MS reports a relationship with UNEEG medical that includes: board membership and consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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