Mapping Regional Variation in Referrals to the Children's Epilepsy Surgery Service

Strategic Insights -

Research from Emily Simmons and colleagues reveals a novel methodology to analyze regional variation in referrals to the Children's Epilepsy Surgery Service (CESS). The study aimed to identify any regional disparities and explore the relationship between referrals and deprivation. The mapping tool was applied to CESS referrals between April 2017 and March 2022 and posterior urethral valve (PUV) surgery referrals between January 2013 and June 2023. The results showed a wide range of referral incidence per million under-18s, with CESS referrals ranging from 30.06 to 39.9 and PUV referrals ranging from 12.0 to 46.9. The analysis found no significant relationship between referral incidence and deprivation, indicating equity in CESS referrals within the region.

Key Takeaways:

  • The study developed a mapping tool to visualize CESS referrals, identifying regional disparities and exploring the relationship between referrals and deprivation.
  • The tool was applied to 291 CESS referrals between April 2017 and March 2022 and 212 PUV surgery referrals between January 2013 and June 2023.
  • The analysis revealed a statistically significant difference in variability between CESS and PUV referral incidences (p = 0.04).
  • Referral incidence was independent of deprivation in both CESS and PUV referrals (p = 0.29 and p = 0.13, respectively).
  • The mapping tool is widely applicable, providing visually representable referral data without being patient-identifiable.
  • Emily Simmons and colleagues used the Orion registry to record CESS referrals and mapped PUV surgery referrals to a tertiary center in the same region.
  • The study included 291 CESS referrals and 212 PUV surgery referrals, with referral incidence calculated and visualized with choropleth maps.

Statistics:

  • CESS referrals ranged from 30.06 to 39.9 per million under-18s.
  • PUV referral incidence ranged from 12.0 to 46.9 per million under-18 males.
  • The analysis found a statistically significant difference in variability between CESS and PUV referral incidences (p = 0.04).
  • Referral incidence was independent of deprivation in both CESS and PUV referrals (p = 0.29 and p = 0.13, respectively).

Sources:

  • Analysing Regional Variation in Referrals to the Children's Epilepsy Surgery Service: A Novel Methodology. Child, 2025;51(6).
  • Wiley-Blackwell. Available online at onlinelibrary.wiley.com/journal/10.1111/(ISSN)1475-3588.
  • Emily Simmons, Orion MedTech Ltd. CIC, Cambridge, UK.
  • Holly Harper, Aswin Chari, Jonathon Holland, Alexis Joannides, and Elaine Hughes.