Veterans Affairs: Central Texas Veterans Health Care System, 2102 Birdcreek Drive, Temple, TX 76502, USA.
BMC Health Serv Res. 2011 Apr 19;11:84. doi: 10.1186/1472-6963-11-84.
Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity).
Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy.
Elderly patients experienced a 15% hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52% hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95% confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95% confidence interval 2.7-8.3).
From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.
尽管存在公认的高风险因素（合并症），但在任何大型研究中都没有描述与老年新发癫痫相关的住院利用情况。
使用来自退伍军人健康管理局的行政数据（2001 年 10 月至 2005 年 9 月）进行回顾性研究，该数据来自全国范围内年龄在 66 岁以上的 824,483 名患者的回顾性观察性治疗老年癫痫研究（TIGER）研究。分析了精神病和医疗住院的情况，作为患者人口统计学，合并的精神、神经和其他医疗状况以及新发癫痫的函数。
总体而言，老年患者在 FY00 中经历了 15%的住院率，但新发癫痫患者（n=1,610）的住院率为 52%。新发癫痫与精神病入院的相对优势比增加三倍，与医疗入院的相对优势比增加近五倍。在新发癫痫患者中，酒精依赖症与癫痫发作后第一年精神病入院的相关性最强（优势比=5.2；95%置信区间 2.6-10.0），而对于医疗入院，最强的因素是心肌梗死（优势比=4.7；95%置信区间 2.7-8.3）。
从患者的角度来看，新发癫痫与医疗入院的风险增加以及精神病入院的风险增加有关。从分析的角度来看，省略癫痫和其他神经状况可能导致仅归因于精神状况的入院风险估计过高。最后，从卫生系统的角度来看，具有相当多合并症和对医疗资源需求的癫痫患者的新兴情况可能需要制定实践指南，以改善护理的协调提供。
