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Objective
Epilepsy Monitoring Units (EMUs) in Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) are critical for the diagnosis and management of seizure disorders. Whether a shorter length of stay (LOS) in the EMU due to scheduling impacts diagnostic yield is unclear.
Methods
Data from 7074 EMU visits across 15 VHA EMUs (2012–2024) were analyzed. Based on usual admission schedules, EMUs were divided into “fixed” (typically Monday–Friday) or “flexible” subgroups. Diagnostic outcomes were classified as epileptic seizures (ES), psychogenic non‐epileptic seizures (PNES), other non‐epileptic events, and inconclusive. Diagnostic rates were compared between fixed and flexible sites using cumulative distribution functions and other statistical tests. Readmission data for initially inconclusive cases were also examined.
Results
Diagnostic outcomes showed the following distribution: 23% ES, 19% PNES, 11% other non‐epileptic events, and 47% inconclusive. Similar distributions were seen between fixed and flexible sites, although a higher proportion of diagnostic admissions were completed earlier in fixed sites and over a longer average LOS at flexible sites. Admissions diagnostic of ES had longer LOS than all other outcomes (4.5 vs. 3.8 days,
Significance
About half of EMU admissions within VHA were non‐diagnostic with respect to the patients' typical clinical events. ES and PNES were observed at approximately similar rates, although the diagnosis of ES required a longer LOS. Fixed sites did not appear inferior to flexible sites for reaching diagnostic conclusions in our analysis. The higher proportion of earlier diagnoses at fixed sites observed was likely a statistical effect of their predefined shorter admission lengths. Further investigations of EMU resource utilization based on individual goals of monitoring are necessary to better examine and improve efficiency.
Plain Language Summary
Epilepsy Monitoring Units (EMUs) are specialized hospital units used to diagnose and characterize seizures. This study looked at over 7000 admissions across 15 Veterans Health Administration EMUs to see whether length of stay affected diagnosis rates based on admission scheduling and seizure types. Regardless of whether patients were admitted on a fixed schedule (Monday–Friday) or a flexible schedule, about half of hospitalizations did not capture typical events. Diagnosis of epileptic seizures and psychogenic non‐epileptic seizures occurred at similar rates, though diagnosing epileptic seizures took longer. Findings suggest fixed (shorter) hospital stays may be as effective as longer flexible hospitalizations.
Details
; Smith, Autumn 1 ; Gopinath Karicheri, Sruthi 1 ; Haroun, Khadar 2 ; Khan, Omar 3 ; Lopez, Maria R. 4
; Eisenschenk, Stephan 5 ; Jones, John 6 ; Reeder, Stephanie 7 ; Towne, Alan R. 8 ; Ransom, Christopher 9 ; Medin, Karen 10 ; Chen, James 11 ; Tran, Tung 12 ; Garga, Nina I. 13 ; Rincon‐Flores, Noemi 14 ; Kellogg, Marissa 15 ; Tobochnik, Steven 2
; Haneef, Zulfi 1 1 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA, Michael E DeBakey VA Medical Center, Houston, Texas, USA
2 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Department of Neurology, VA Boston Healthcare System, Boston, Massachusetts, USA
3 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Baltimore VA Medical Center, Baltimore, Maryland, USA
4 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Bruce Carter VA Medical Center, Miami, Florida, USA, Miller School of Medicine, University of Miami, Miami, Florida, USA
5 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Malcolm Randall VA Medical Center, Gainesville, Florida, USA, University of Florida Health, Gainesville, Florida, USA
6 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, William S. Middleton VA Medical Center, Madison, Wisconsin, USA
7 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
8 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
9 VA Puget Sound Health Care System, Seattle, Washington, USA
10 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, West Haven VA Medical Center, West Haven, Connecticut, USA, Yale School of Medicine, New Haven, Connecticut, USA
11 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Greater Los Angeles VA Medical Center, Los Angeles, California, USA
12 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Durham VA Medical Center, Durham, North Carolina, USA, Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
13 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Department of Neurology, University of California, san Francisco School of Medicine, San Francisco, California, USA, San Francisco VA Medical Center, San Francisco, California, USA
14 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, James A. Haley Veteran's Hospital, Tampa, Florida, USA
15 Epilepsy Centers of Excellence, Veterans Health Administration, Washington, District of Columbia, USA, Portland VA Medical Center, Portland, Oregon, USA