ORCID

Abstract

Background: Recurrent seizure-related emergency department (ED) attendances are common and associated with poor outcomes. We aimed to identify factors associated with repeated seizure-related ED use and to develop a mortality risk score among individuals re-attending with seizures. Methods: We conducted a retrospective cohort study across two district general hospitals in South-West England, Royal Cornwall Hospitals NHS Trust (RCH; 2015–2018) and Royal United Hospitals Bath NHS Trust (RUH; 2018–2022). Adults (≥18 years) with ≥2 seizure-related ED attendances were included. Negative binomial regression was used to examine demographic and clinical predictors of repeat attendances. A risk score based on these predictors was developed and applied to individuals presenting with a first seizure. Cox proportional hazards models estimated the association between risk score tertiles and all-cause mortality, adjusted for age and sex. Results: A total of 997 patients were included (RUH n = 547; RCH n = 450). Increased frequency of seizure-related ED attendances was independently associated with higher socioeconomic deprivation (IRR 1.16, p = 0.01), homelessness (IRR 1.76, p < 0.01), and mental health conditions (IRR 1.24, p < 0.01). Intellectual disability showed a marginal association (IRR 1.12, p = 0.09). Among patients with a first seizure, those in the middle risk score tertile had significantly increased mortality risk at RUH (HR 2.14, 95 % CI 1.05–4.34). Associations were not statistically significant at RCH. Conclusions: Sociodemographic and clinical factors contribute to repeated seizure-related ED attendances. A simple risk score may stratify mortality risk after first seizure reattendance, warranting further validation. Targeted multidisciplinary interventions may improve outcomes and reduce unnecessary ED use.

Publication Date

2025-11-01

Publication Title

Seizure: European Journal of Epilepsy

Volume

132

ISSN

1059-1311

Acceptance Date

2025-07-31

Deposit Date

2025-08-01

Funding

We are grateful to LivaNova USA for an Investigator Initiated Research Grant and Mrs Katherine Eggleston LivaNova USA. Funding This research received funding from LivaNova as an investigator-initiated grant.

Keywords

Emergency department, Homelessness, Mental heath, Premature mortality, Socio-economic deprivation, Substance misuse

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

First Page

46

Last Page

53

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PIIS1059131125001943.pdf (984 kB)

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