Unplanned Admissions, Emergency Department Visits, and Epilepsy After Critical Neurological Illness Requiring Prolonged Mechanical Ventilation in Children

Matthew B Spear; Kristen Miller; Craig Press; Christopher Ruzas; Jaime LaVelle; Peter M Mourani; Tellen D Bennett; Aline B Maddux

doi:10.1177/19418744221123628

Unplanned Admissions, Emergency Department Visits, and Epilepsy After Critical Neurological Illness Requiring Prolonged Mechanical Ventilation in Children

Neurohospitalist. 2023 Jan;13(1):31-39. doi: 10.1177/19418744221123628. Epub 2022 Oct 9.

Authors

Matthew B Spear¹, Kristen Miller², Craig Press³, Christopher Ruzas⁴, Jaime LaVelle⁵, Peter M Mourani⁶, Tellen D Bennett^{4

7}, Aline B Maddux⁴

Affiliations

¹ Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA.
² Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
³ Department of Pediatrics, Division of Neurology, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁵ Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.
⁶ Department of Pediatrics, Section of Critical Care, University of Arkansas for Medical Sciences and Arkansas Children's, Little Rock, AR, USA.
⁷ Department of Pediatrics, Section of Informatics and Data Science, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.

Abstract

Background and purpose: Long-term outcomes after pediatric neurocritical illness are poorly characterized. This study aims to characterize the frequency and risk factors for post-discharge unplanned health resource use in a pediatric neurocritical care population using insurance claims data.

Methods: Retrospective cohort study evaluating children who survived a hospitalization for an acute neurologic illness or injury requiring mechanical ventilation for >72 hours and had insurance eligibility in Colorado's All Payers Claims database. Insurance claims identified unplanned readmissions and emergency department [ED] visits during the post-discharge year. For patients without pre-existing epilepsy/seizures, we evaluated for post-ICU epilepsy identified by claim(s) for a maintenance anti-seizure medication during months 6-12 post-discharge. Multivariable logistic regression identified factors associated with each outcome.

Results: 101 children, median age 3.7 years (interquartile range (IQR) .4-11.9), admitted for trauma (57%), hypoxic-ischemic injury (17%) and seizures (15%). During the post-discharge year, 4 (4%) patients died, 26 (26%) were readmitted, and 48 (48%) had an ED visit. Having a pre-existing complex chronic condition was independently associated with readmission and emergency department visit. Admission for trauma was protective against readmission. Of those without pre-existing seizures (n = 86), 25 (29%) developed post-ICU epilepsy. Acute seizures during admission and prolonged ICU stays were independently associated with post-ICU epilepsy.

Conclusions: Survivors of pediatric neurocritical illness are at risk of unplanned healthcare use and post-ICU epilepsy. Critical illness risk factors including prolonged ICU stay and acute seizures may identify cohorts for targeted follow up or interventions to prevent unplanned healthcare use and post-ICU epilepsy.

Keywords: administrative claims; brain injuries; child; critical care outcomes; healthcare; intensive care units; pediatric.

Grants and funding

K23 HD096018/HD/NICHD NIH HHS/United States