Dickson Jon Mark, Dudhill Hannah, Shewan Jane, Mason Sue, Grünewald Richard A, Reuber Markus
The Academic Unit of Primary Medical Care, The Medical School, Sheffield, England.
Sheffield Medical School, The University of Sheffield, Sheffield, South Yorkshire, UK.
BMJ Open. 2017 Jul 13;7(7):e015696. doi: 10.1136/bmjopen-2016-015696.
To determine the clinical characteristics, management and outcomes of patients taken to hospital by emergency ambulance after a suspected seizure.
Quantitative cross-sectional retrospective study of a consecutive series of patients.
An acute hospital trust in a large city in England.
In 2012-2013, the regions' ambulance service managed 605 481 emergency incidents, 74 141/605 481 originated from Sheffield (a large city in the region), 2121/74 141 (2.9%) were suspected seizures and 178/2121 occurred in May 2012. We undertook detailed analysis of the medical records of the 91/178 patients who were transported to the city's acute hospital. After undertaking a retrospective review of the medical records, the best available aetiological explanation for the seizures was determined.
The best available aetiological explanation for 74.7% (68/91) of the incidents was an epileptic seizure, 11.0% (10/91) were psychogenic non-epileptic seizures and 9.9% (9/91) were cardiogenic events. The epileptic seizures fall into the following four categories: first epileptic seizure (13.2%, 12/91), epileptic seizure with a historical diagnosis of epilepsy (30.8%, 28/91), recurrent epileptic seizures without a historical diagnosis of epilepsy (20.9%, 19/91) and acute symptomatic seizures (9.9%, 9/91). Of those with seizures (excluding cardiogenic events), 2.4% (2/82) of patients were seizing on arrival in the Emergency Department (ED), 19.5% (16/82) were postictal and 69.5% (57/82) were alert. 63.4% (52/82) were discharged at the end of their ED attendance and 36.5% (19/52) of these had no referral or follow-up.
Most suspected seizures are epileptic seizures but this is a diagnostically heterogeneous group. Only a small minority of patients require emergency medical care but most are transported to hospital. Few patients receive expert review and many are discharged home without referral to a specialist leaving them at risk of further seizures and the associated morbidity, mortality and health services costs of poorly controlled epilepsy.
确定疑似癫痫发作后由急诊救护车送往医院的患者的临床特征、治疗及转归。
对一系列连续患者进行的定量横断面回顾性研究。
英国某大城市的一家急症医院信托机构。
2012 - 2013年，该地区的救护车服务部门处理了605481起紧急事件，其中74141起（占605481起的比例）来自谢菲尔德（该地区的一个大城市），2121起（占74141起的2.9%）为疑似癫痫发作，178起（占2121起的比例）发生在2012年5月。我们对被送往该市急症医院的91名（占178名患者的比例）患者的病历进行了详细分析。在对病历进行回顾性审查后，确定了癫痫发作的最佳病因解释。
74.7%（68/91）的事件的最佳病因解释为癫痫发作，11.0%（10/91）为心因性非癫痫发作，9.9%（9/91）为心源性事件。癫痫发作分为以下四类：首次癫痫发作（13.2%，12/91）、有癫痫病史诊断的癫痫发作（30.8%，28/91）、无癫痫病史诊断的复发性癫痫发作（20.9%，19/91）和急性症状性癫痫发作（9.9%，9/91）。在有癫痫发作的患者中（不包括心源性事件），2.4%（2/82）的患者在到达急诊科时仍在发作，19.5%（16/82）处于发作后状态，69.5%（57/82）意识清醒。63.4%（52/82）的患者在急诊科就诊结束时出院，其中36.5%（19/52）没有转诊或随访。
大多数疑似癫痫发作是癫痫发作，但这是一个诊断上异质性的群体。只有少数患者需要紧急医疗护理，但大多数患者被送往医院。很少有患者接受专家评估，许多患者在未转诊至专科医生的情况下出院回家，这使他们面临癫痫进一步发作以及癫痫控制不佳所带来的相关发病率、死亡率和医疗服务费用的风险。
