Access to inpatient video-EEG monitoring for patients with frequent seizure-related emergency visits

BACKGROUND: While inpatient video-EEG monitoring (vEEG) is a vital diagnostic tool for epilepsy, it remains unknown whether access to this service is equitably distributed. We hypothesized that minoritized race/ethnicity, lack of insurance, low socioeconomic status, and distance from an epilepsy center are associated with decreased receipt of vEEG among patients with frequent seizure-related emergency department (ED) visits. METHODS: This retrospective cohort study analyzed patients with frequent ED visits for seizure/epilepsy in four US states (Florida, Maryland, New York, and Wisconsin) between 2016 and 2018. We used multivariable logistic regression to evaluate the odds of receiving inpatient vEEG relative to race/ethnicity, insurance, median income by zip code, and proximity to an epilepsy center. RESULTS: Of 28,598 patients with frequent ED visits, 458 (1.6%) received vEEG. No significant association was found for race/ethnicity. However, patients without insurance (adjusted odds ratio [aOR] 0.37, 95% confidence interval [CI]: 0.24-0.55) and those living in the lowest income quartile zip codes (aOR 0.48, 95%CI: 0.35-0.64) were less likely to undergo vEEG. On the other hand, living in a county with or adjacent to an accredited epilepsy center increased the likelihood of vEEG (aOR 1.75, 95%CI: 1.12-2.71 and aOR 1.80, 95%CI: 1.18-2.74, respectively). CONCLUSION: Socioeconomic and geographic factors are significant barriers to receiving vEEG. Improving the distribution of epilepsy services and addressing obstacles may help reduce disparities among vulnerable populations with high ED utilization.