Risk factors to predict mortality in people with seizures reattending emergency departments: a dual-centre study

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. 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. 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. 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.