Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202-3591, USA.
Epilepsia. 2010 May;51(5):862-7. doi: 10.1111/j.1528-1167.2009.02492.x. Epub 2010 Jan 7.
Controlling for injury and patient characteristics, one would expect comparable in-hospital outcomes for injured patients with and without epilepsy. The historical stigma associated with epilepsy is well-documented, yet potential disparities in injury care for people with epilepsy/seizures have not been examined. We compared in-hospital outcomes of injured patients with epilepsy/seizures with patients without epilepsy/seizures and tested the hypothesis that injured people with epilepsy have worse outcomes.
Existing data were analyzed from the Nationwide Inpatient Sample-the largest, longitudinal, all-payer inpatient care database in the United States. Injured patients of all ages were included. Multivariable logistic regression was used to control for patient and hospital characteristics.
In-hospital mortality.
When controlling for patient and injury characteristics, our results show that people with epilepsy/seizures were more likely to die in-hospital than people without epilepsy [odds ratio (OR) 1.17, p < 0.001]. People with epilepsy were significantly more likely to have a traumatic brain injury diagnosis than similar individuals without epilepsy (unintentional injuries OR 2.81, p < 0.001; interpersonal violence OR 6.0, p < 0.001). By mechanism of injury, significantly increased risk of death was observed for injuries from falls (OR 1.21, p < 0.001), other transport injuries (OR 2.04, p = 0.01), struck by/against (OR 1.85, p = 0.02), and suffocation (OR 10.93, p = 0.009). People with epilepsy/seizures receiving firearm injuries were less likely to die in-hospital (OR 0.25, p < 0.001).
Disparities in hospital outcomes for people with epilepsy deserve further attention. Identifying the underlying causes of these disparities will allow for the development of targeted prevention interventions.
在控制损伤和患者特征的情况下，人们预计患有癫痫和无癫痫的受伤患者的院内结局相当。与癫痫相关的历史耻辱是有据可查的，但尚未检查癫痫患者的受伤护理是否存在潜在差异。我们比较了有癫痫/发作的受伤患者与无癫痫/发作的患者的院内结局，并检验了癫痫患者的受伤结局更差的假设。
利用美国最大的、纵向的、所有支付者住院患者护理数据库——全国住院患者样本中的现有数据进行分析。纳入了所有年龄段的受伤患者。采用多变量逻辑回归控制患者和医院特征。
院内死亡率。
在控制患者和损伤特征后，我们的结果表明，癫痫患者比无癫痫患者更有可能在院内死亡[比值比（OR）1.17，p<0.001]。癫痫患者更有可能被诊断为创伤性脑损伤，而无癫痫的相似患者则不然（非故意伤害 OR 2.81，p<0.001；人际暴力 OR 6.0，p<0.001）。按损伤机制，观察到从跌倒（OR 1.21，p<0.001）、其他运输损伤（OR 2.04，p=0.01）、被击中/碰撞（OR 1.85，p=0.02）和窒息（OR 10.93，p=0.009）引起的损伤死亡风险显著增加。接受火器伤害的癫痫患者在院内死亡的可能性较低（OR 0.25，p<0.001）。
癫痫患者的医院结局差异值得进一步关注。确定这些差异的根本原因将有助于制定有针对性的预防干预措施。
