Dickson Jon M, Taylor Louise H, Shewan Jane, Baldwin Trevor, Grünewald Richard A, Reuber Markus
Academic Unit of Primary Medical Care, The University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield, UK.
The Medical School, The University of Sheffield, Sheffield, UK.
BMJ Open. 2016 Feb 23;6(2):e010573. doi: 10.1136/bmjopen-2015-010573.
Suspected seizures are a common reason for emergency calls to ambulance services. Prehospital management of these patients is an important element of good quality care. The aim of this study, conducted in a regional ambulance service in the UK, was to quantify the number of emergency telephone calls for suspected seizures in adults, the associated costs, and to describe the patients' characteristics, their prehospital management and their immediate outcomes.
Quantitative cross-sectional study using routinely collected data and a detailed review of the clinical records of a consecutive series of adult patients (≥ 16 years).
A regional ambulance service within the National Health Service in England.
Cross-sectional data from all 605,481 adult emergency incidents managed by the ambulance service from 1 April 2012 to 31 March 2013. We selected a consecutive series of 178 individual incidents from May 2012 for more detailed analysis (132 after exclusions and removal of non-seizure cases).
Suspected seizures made up 3.3% of all emergency incidents. True medical emergencies were uncommon but 3.3% had partially occluded airways, 6.8% had ongoing seizure activity and 59.1% had clinical problems in addition to the seizure (29.1% involving injury). Emergency vehicles were dispatched for 97.2% of suspected seizures, the seizure had terminated on arrival in 93.2% of incidents, 75% of these patients were transported to hospital. The estimated emergency management cost per annum of suspected seizures in the English ambulance services is £45.2 million (€64.0 million, $68.6 million).
Many patients with suspected seizures could potentially be treated more effectively and at lower cost by modifying ambulance call handling protocols. The development of innovative care pathways could give call handlers and paramedics alternatives to hospital transportation. Increased adoption of care plans could reduce 999 calls and could increase the rates of successful home or community treatment.
疑似癫痫发作是呼叫救护车服务的常见原因。对这些患者的院前管理是优质护理的重要组成部分。本研究在英国一家地区救护车服务机构开展，旨在量化成人疑似癫痫发作的紧急电话数量、相关成本，并描述患者特征、院前管理及直接转归。
采用常规收集的数据进行定量横断面研究，并对一系列连续的成年患者（≥16岁）的临床记录进行详细回顾。
英国国家医疗服务体系内的一家地区救护车服务机构。
2012年4月1日至2013年3月31日期间该救护车服务机构处理的所有605481起成人紧急事件的横断面数据。我们从2012年5月选取了一系列连续的178起单独事件进行更详细分析（排除非癫痫发作病例后为132起）。
疑似癫痫发作占所有紧急事件的3.3%。真正的医疗紧急情况并不常见，但3.3%的患者气道部分阻塞，6.8%的患者癫痫发作仍在持续，59.1%的患者除癫痫发作外还有临床问题（29.1%涉及损伤）。97.2%的疑似癫痫发作事件派遣了急救车辆，93.2%的事件在到达时癫痫发作已终止，其中75%的患者被送往医院。英国救护车服务机构每年疑似癫痫发作的紧急管理估计成本为4520万英镑（6400万欧元，6860万美元）。
通过修改救护车呼叫处理方案，许多疑似癫痫发作的患者可能会得到更有效的治疗且成本更低。创新护理路径的开发可为呼叫处理人员和护理人员提供替代医院转运的方案。更多地采用护理计划可减少999电话呼叫，并可提高家庭或社区成功治疗的比例。
