The University of Sheffield, The Academic Unit of Primary Medical Care, The Medical School, Sheffield, S5 7 AU, UK.
University of Lincoln, Community and Health Research Unit, School of Health and Social Care, Brayford pool, Lincoln, Lincolnshire, LN6 7TS, UK.
Seizure. 2018 Apr;57:38-44. doi: 10.1016/j.seizure.2018.03.006. Epub 2018 Mar 8.
We aimed to investigate the characteristics of patients presenting to the ambulance service with suspected seizures, the costs of managing these patients and the factors which predicted transport to hospital.
We employed a cross-sectional design using routine clinical data from a UK regional ambulance service. Logistic regression was used to identify predictors of transport to hospital from ambulance response times, demographics, clinical (physiological) findings and treatments.
There were 177,715 emergency incidents recorded in 2011/12 of which 2.9% (5139/177,715) were classified as seizures by ambulance call handlers and 2.7% (4884/177,715) by paramedics on the scene. Suspected seizures were the seventh most common call type. The annual cost of managing these incidents was £890,148. Clinical and physiological variables were normal for most patients. 59.3% (2894/4884) of patients were transported to hospital. 1/4884 (0.02%) patient died. Administration of diazepam, insertion of an airway and pyrexia perfectly predicted transport to hospital, tachycardia had a modest association, but other variables were only weak predictors of transport to hospital.
This study shows that most patients after a suspected seizure are not acutely unwell but nevertheless most patients are transported to hospital. Further research is required to determine which factors are important in decisions to transport to hospital and to create evidence-based tools to help paramedics identify patients who could be safely managed without transport to hospital.
我们旨在研究因疑似癫痫发作而向救护车服务机构就诊的患者的特征、这些患者的治疗费用以及预测送往医院的因素。
我们采用了横断面设计，使用了英国地区救护车服务机构的常规临床数据。逻辑回归用于从救护车反应时间、人口统计学、临床（生理）发现和治疗中识别送往医院的预测因素。
在 2011/12 年记录的 177715 次紧急事件中，有 2.9%（5139/177715）被救护车接线员归类为癫痫发作，2.7%（4884/177715）被现场护理人员归类为癫痫发作。疑似癫痫发作是第七大常见的呼叫类型。管理这些事件的年度费用为 890148 英镑。大多数患者的临床和生理变量正常。59.3%（2894/4884）的患者被送往医院。有 1/4884（0.02%）名患者死亡。地西泮的给药、气道的插入和发热完美地预测了送往医院，心动过速有一定的关联，但其他变量只是送往医院的弱预测因素。
本研究表明，大多数疑似癫痫发作后的患者病情并不危急，但大多数患者仍被送往医院。需要进一步研究以确定决定送往医院的因素哪些是重要的，并创建循证工具，帮助护理人员识别可以安全管理而无需送往医院的患者。
