Trends in Status Epilepticus-Related Hospitalizations and Mortality Redefined in US Practice Over Time
Trends in Status Epilepticus-Related Hospitalizations and Mortality Redefined in US Practice Over Time
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DOI：
10.1001/jamaneurol.2015.0188
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发表时间：
2015-06-01
期刊：
影响因子：
29
通讯作者：
Burke, James F.
中科院分区：
文献类型：
--
作者：
Betjemann, John P.;Josephson, S. Andrew;Burke, James F.
癫痫持续状态是一种常见的神经系统急症，与发病率、死亡率和医疗费用显著相关，但癫痫持续状态相关住院率和死亡率的详细趋势数据有限。我们进行了2项回顾性系列横断面研究，包括408304例癫痫持续状态相关的医院就诊，使用的是1月1日以来的可推广的国家数据，1999年至2010年12月31日，来自疾病控制和预防中心和全国住院患者样本。疾病控制和预防中心的死亡证明数据，使用国际疾病统计分类，第十次修订，代码，被用来确定非标准化和年龄标准化的癫痫持续状态的死亡率在美国的根本原因。从全国住院患者样本的数据被用来估计人口标准化癫痫持续状态相关的住院率使用国际疾病统计分类，第九次修订，codes.Main结局和措施癫痫持续状态相关的住院治疗进行了分类，是否癫痫持续状态是主要的诊断，是否插管，并通过主要的保险类型。时间趋势进行了测试，使用泊松回归和总结与季度发病率ratios.RESULTS在2010年，癫痫持续状态是613例死亡（约2每100万人）的报告的潜在死因。每100万人中癫痫持续状态相关死亡率仅增加5.6%（事故率比，1.004; 95% CI，1.002-1.006），从1999年的1.79降至2010年的1.89，而每10万人因癫痫持续状态而住院的人口标准化人数增加了56.4%（发病率比，1.013; 95%CI，1.012-1.013）从1999年的8.86降至2010年的13.86。在非主要诊断为癫痫持续状态的插管患者中观察到最大增幅（181.6%;发生率比，1.030; 95% CI，1.029-1.030）。在不同的保险供应商，最大的增长（81.3%）是在Medicare patients.CONCLUSIONS和RELEVANCE之间存在一个断开相对稳定的癫痫持续状态相关的死亡率和癫痫持续状态住院治疗的显着增加，可能反映了癫痫持续状态的诊断，通过提高诊断的敏感性和改变计费和编码。癫痫持续状态的定义和一般方法，包括资源的使用，应该随着这些不断变化的流行病学趋势而发展。
IMPORTANCE Status epilepticus is a common neurologic emergency with significant associated morbidity, mortality, and health care costs, yet limited data exist detailing trends in status epilepticus-related hospitalizations and mortality.OBJECTIVE To examine trends in status epilepticus-related hospitalizations and mortality.DESIGN, SETTING, AND PARTICIPANTS We performed 2 retrospective serial cross-sectional studies including 408 304 status epilepticus-related hospital visits using generalizable national data from January 1, 1999, to December 31, 2010, from the Centers for Disease Control and Prevention and the Nationwide Inpatient Sample. Centers for Disease Control and Prevention death certificate data, using International Statistical Classification of Diseases, Tenth Revision, codes, were used to determine nonstandardized and age-standardized rates of status epilepticus as the underlying cause of death in the United States. Data from the Nationwide Inpatient Sample were used to estimate population-standardized status epilepticus-related hospitalization rates using International Statistical Classification of Diseases, Ninth Revision, codes.MAIN OUTCOMES AND MEASURES Status epilepticus-related hospitalizations were categorized by whether status epilepticus was the principal diagnosis, whether the patient was intubated, and by primary insurance type. Temporal trends were tested using Poisson regression and summarized with quarterly incident rate ratios.RESULTS In 2010, status epilepticus was the reported underlying cause of death in 613 deaths (approximately 2 per 1 000 000 persons). Age-standardized status epilepticus-related mortality per 1 000 000 persons increased by only 5.6% (incident rate ratio, 1.004; 95% CI, 1.002-1.006) from 1.79 in 1999 to 1.89 in 2010, while population-standardized hospitalizations for status epilepticus per 100 000 persons increased by 56.4% (incident rate ratio, 1.013; 95% CI, 1.012-1.013) from 8.86 in 1999 to 13.86 in 2010. The largest increase (181.6%; incident rate ratio, 1.030; 95% CI, 1.029-1.030) was seen among intubated patients with nonprincipal diagnoses of status epilepticus. Among varied insurance providers, the largest increase (81.3%) was seen in Medicare patients.CONCLUSIONS AND RELEVANCE A disconnect exists between the relatively stable status epilepticus-related mortality and the marked increase in status epilepticus hospitalizations, likely reflecting an increase in status epilepticus diagnoses through improved diagnostic sensitivity and changes in billing and coding. The definition and general approach to status epilepticus, including resource use, should evolve with these changing epidemiologic trends.