# Processes and Predictors in the Transition From Pediatric to Adult Epilepsy Care: A Retrospective Study at a Single Institution

## TL;DR

This study examines how patients with epilepsy transition from pediatric to adult care at a hospital without a formal transition program.

## Contribution

The study identifies predictors of transition discussions and transfers to adult care in epilepsy patients.

## Key findings

- Only 25% of patients had a documented transition discussion.
- Older age and absence of intellectual disability predicted transition discussions.
- Formal transition programs may be needed to improve care processes.

## Abstract

To characterize transition of care processes for patients with epilepsy in a single institution without a formal epilepsy transition of care program.

We reviewed medical records for individuals with epilepsy who were at least 15 years old seen outpatient by pediatric neurology in 2019. We followed their records through 2022. We evaluated whether they had documentation of transition discussion, if they transferred to adult care, and/or if they were retained in adult care. Excluding individuals who died or were discharged, we performed logistic regression for transition discussion, transfer, and retention, adjusting for sex, age, race/ethnicity, distance from institution, zip code median household income, rurality, drug-resistant epilepsy (DRE), intellectual disability (ID), and technology dependence.

We evaluated documentation for 274 individuals (50% female, median age 18 years, 84% white, 1.5% Hispanic, 24% DRE, 25% ID). Excluding 14 who died and 28 who were discharged, 57 of 226 (25%) had a documented transition discussion and 115 (51%) transitioned (median age 20 years). Of 95 eligible individuals, 77 (81%) were retained in adult care. Predictors of transition discussion included older age (aOR: 1.44, 95% confidence interval: 1.22, 1.70) and absence of ID (aOR: 4.17 [1.51, 11.11]). Predictors of transfer included older age (aOR: 1.19 [1.02, 1.39]), documented transition discussion (aOR: 3.25 [1.48, 7.13]), and DRE (aOR: 2.41 [1.10, 5.28]). We identified no significant predictors of retention.

Discussion of transition may promote transfer to adult care among people with epilepsy. Formal transition programs may be needed to optimize care processes.