Seizure visits in US emergency departments: epidemiology and potential disparities in care
Seizure visits in US emergency departments: epidemiology and potential disparities in care
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DOI：
10.1007/s12245-008-0024-4
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发表时间：
2008-01-01
影响因子：
3.2
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Pallin, Daniel J.;Goldstein, Joshua N.;Camargo, Carlos A., Jr.
简介 虽然癫痫是一种特征明确的疾病，但大多数因“癫痫发作”而到急诊室 (ED) 就诊的患者均未患有已知的癫痫病。癫痫发作的流行病学和国家管理模式尚不清楚。本次调查的目的是描述美国大型代表性样本中因癫痫发作就诊的特征，并调查种族或族裔对治疗的任何潜在影响。方法对 1993 年至 2003 年国家医院流动医疗调查 (NHAMCS) 的癫痫就诊进行了分析。使用受控多元逻辑回归分析与美国就诊、神经影像学和入院相关的人口统计学因素。 结果 癫痫每年导致 100 万次急诊就诊 [95% 置信区间 (CI)：926,000-1,040,000]，占美国所有急诊就诊的 1%。就诊最常见的是婴儿，每 1,000 人中有 8.0 次就诊（95% CI：6.010.0）和 1-5 岁儿童（7.4；95% CI：6.4-8.4）。与酒精相关就诊的患者中癫痫发作的可能性更大[比值比 (OR)：3.2； 95% CI：2.7-3.9]、男性（OR：1.4；95% CI：1.3-1.5）和黑人（OR：1.4；95% CI：1.31.6）。神经影像学在黑人中的使用率低于白人（OR：0.6；95% CI：0.4-0.8），在西班牙裔中的使用率低于非西班牙裔（OR：0.6；95% CI：0.4-0.9）。与私人保险相比，神经影像学在参加 Medicare（OR：0.4；95% CI：0.2-0.6）或 Medicaid（OR：0.5；95% CI：0.4-0.7）的患者中使用较少，在专营医院中也较少使用。与白人相比，黑人入院的可能性较小（OR：0.6；95% CI：0.4-0.8）。结论 癫痫发作占急诊就诊人数的 1%（每年 100 万人）。在婴儿和幼儿、男性和黑人中，癫痫就诊的比例较高。神经影像学和入院方面的种族/民族差异值得进一步研究。
Introduction While epilepsy is a well-characterized disease, the majority of emergency department (ED) visits for "seizure" involve patients without known epilepsy. The epidemiology of seizure presentations and national patterns of management are unclear. The aim of this investigation was to characterize ED visits for seizure in a large representative US sample and investigate any potential impact of race or ethnicity on management.Methods Seizure visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1993 to 2003 were analysed. Demographic factors associated with presentation, neuroimaging and hospital admission in the USA were analysed using controlled multivariate logistic regression.Results Seizure accounts for 1 million ED visits annually [95% confidence interval (CI): 926,000-1,040,000], or 1% of all ED visits in the USA. Visits were most common among infants, at 8.0 per 1,000 population (95% CI: 6.010.0), and children aged 1-5 years (7.4; 95% CI: 6.4-8.4). Seizure was more likely among those with alcohol-related visits [odds ratio (OR): 3.2; 95% CI: 2.7-3.9], males (OR: 1.4; 95% CI: 1.3-1.5) and Blacks (OR: 1.4; 95% CI: 1.31.6). Neuroimaging was used less in Blacks than Whites (OR: 0.6; 95% CI: 0.4-0.8) and less in Hispanics than non-Hispanics (OR: 0.6; 95% CI: 0.4-0.9). Neuroimaging was used less among patients with Medicare (OR: 0.4; 95% CI: 0.2-0.6) or Medicaid (OR: 0.5; 95% CI: 0.4-0.7) vs private insurance and less in proprietary hospitals. Hospital admission was less likely for Blacks vs Whites (OR: 0.6; 95% CI: 0.4-0.8).Conclusion Seizures account for 1% of ED visits (1 million annually). Seizure accounts for higher proportions of ED visits among infants and toddlers, males and Blacks. Racial/ethnic disparities in neuroimaging and hospital admission merit further investigation.