Does Discharge Diagnosis Determine Risk of Death? Mortality Following Admission to Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) Epilepsy Monitoring Units (EMUs)
Marissa Kellogg1, Megan Amuan2, Jacqueline Hirschey3, W. LaFrance4, Zulfi Haneef5, Hamada Altalib6, Rizwana Rehman7, Mary Jo Pugh8
1Neurology, VA Portland Healthcare System, Dept of Neurology, 2Salt Lake City VA HCS, 3OHSU & Portland VA HCS, 4Rhode Island Hospital, 5Houston VA HCS & Baylor Univ, 6VA Connecticut Healthcare System, 7Durham VA HCS, 8Salt Lake City VA
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.