Early first seizure attendance associated with reduced rates of subsequent hospital utilization: JAMA
Researchers have found that early attendance at first-seizure clinics (FSCs) is associated with reduced rates of subsequent hospital utilization and mortality. This finding underscores the importance of timely specialist care for patients with new-onset undifferentiated seizure events. First-seizure clinics aim to provide prompt specialist care to patients experiencing their first seizure. However, the impact of FSC attendance on long-term health outcomes has been unclear.
The study was published in the journal JAMA Neurology by Yingtong Li. and colleagues. This study, conducted by examining patient records from two major metropolitan public hospitals in Melbourne, Australia, aimed to determine whether FSC attendance and the timing of such attendance influence subsequent healthcare utilization and mortality rates.
This retrospective cohort study analyzed data from patients who booked appointments at FSCs between 2007 and 2018. Patients' records were linked to state-wide administrative databases from 2000 to 2021. The study included patients who were successfully linked for analysis, excluding those who only recorded canceled appointments. The primary exposure was FSC attendance, and the main outcomes were subsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions.
Of 10,162 patients who booked FSC appointments, 9,392 were linked for analysis. The mean follow-up time was 6.9 years. Among these patients, 5,398 were male (57.5%), with a mean age of 59.7 years.
FSC attendance was associated with a significant reduction in subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalizations (aIRR, 0.81; 95% CI, 0.75-0.88).
Patients who attended their first-scheduled FSC appointment, compared to those who attended a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalizations (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98).
Male sex was associated with a higher risk of nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays of more than 14 days between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54).
Hospitalization at referral (aRR, 0.80; 95% CI, 0.72-0.90), non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 miles from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89) were associated with reduced nonattendance.
The study demonstrates that early attendance at FSCs significantly reduces subsequent emergency presentations, hospitalizations, and mortality among patients with new-onset seizures. This highlights the critical role of timely specialist care in managing seizure disorders and suggests that FSCs should be adequately resourced to ensure equitable, timely access for all patients.
Researchers concluded that early attendance at first-seizure clinics is crucial in reducing hospital utilization and improving health outcomes for patients with new-onset seizures. These findings may guide clinicians and healthcare policymakers in optimizing the management and resources of FSCs to enhance patient care.
Reference:
Li, Y., Ren, T., Burgess, M., Chen, Z., Carney, P. W., O’Brien, T. J., Kwan, P., & Foster, E. (2024). Early access to first-seizure clinics, subsequent outcomes, and factors associated with attendance. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.1187
