Impact of length of stay on diagnostic yield in the epilepsy monitoring unit: A multi‐center retrospective 12‐year Veterans Health Administration study

Abstract 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, p