与癫痫相关的机动车事故特征：车祸症候学。
Characteristics of motor vehicle crashes associated with seizure: Car crash semiology.
机构信息
From the Departments of Neurology (A.N., R.C., W.J.D., M.J.C.) and Medicine (W.J.D., M.J.C.), St Vincent's Hospital Melbourne; Department of Medicine, Royal Melbourne Hospital (A.N.), and Graeme Clark Institute (M.J.C.), University of Melbourne; Faculty of Health (R.C.), Deakin University; Victorian Institute of Forensic Medicine, Department of Forensic Medicine (M.O.), Monash University; and Corporate Strategy and Operational Improvement Department (D.B.), Victoria Police, Melbourne, Australia.
出版信息
Neurology. 2018 Sep 18;91(12):e1102-e1111. doi: 10.1212/WNL.0000000000006208. Epub 2018 Aug 22.
OBJECTIVE
To examine the characteristics of seizure-related vehicle crashes (SRC).
METHOD
Using a nested case-control design, we identified and compared cases of SRC involving confirmed epilepsy patients with 137,126 non-seizure-related crash controls (NSRC) in the Australian state of Victoria. SRC were identified from approximately 20,000 epileptologist medical records by cross-referencing this source with the Victorian Police Traffic Incident database and the Road Crash Information System Database (RCISD).
RESULTS
Seventy-one SRC involving 62 patients with epilepsy were identified. Thirty-seven SRC resulted in injury and could be identified in the RCISD and compared to NSRC. Seizure-related crashes typically involved a single vehicle (57% vs 29%, < 0.001) carrying a sole occupant (95% vs 48%, = 0.001). Most SRC began with an "out of control movement" (51% vs 10%, < 0.001) and the subsequent collision type differed significantly between the groups ( < 0.001). The majority of SRC were a "collision with a fixed object" (54% vs 17%, < 0.001) involving an "off path on straight" mechanism (48% vs 10%, < 0.001). Regarding all 71 SRC, generalized as compared with focal epilepsy crashes involved younger drivers ( < 0.001), seizure-provoking factors ( = 0.033), and occurred earlier in the day ( = 0.004).
CONCLUSIONS
Given the distinct SRC features, we propose that clinicians, crash investigators, and driver licensing authorities incorporate collision characteristics into the overall assessment of suspected SRC. Further research should examine restricting driving immediately after risk periods as a harm-minimization strategy.
目的
研究与癫痫发作相关的车辆碰撞（SRC）的特征。
方法
使用巢式病例对照设计，我们从澳大利亚维多利亚州大约 20000 名癫痫专家的病历中通过交叉引用该来源与维多利亚警方交通事件数据库和道路碰撞信息系统数据库（RCISD），确定并比较了 SRC 中确诊癫痫患者的病例与 137126 例非癫痫相关碰撞对照（NSRC）。
结果
共确定了 71 起涉及 62 名癫痫患者的 SRC。其中 37 起 SRC 导致受伤，可在 RCISD 中识别并与 NSRC 进行比较。与 SRC 相关的碰撞通常涉及一辆载有一名唯一乘客的单一车辆（57%对 29%，<0.001）。大多数 SRC 开始时是“失去控制的运动”（51%对 10%，<0.001），随后的碰撞类型在两组之间差异显著（<0.001）。大多数 SRC 是“与固定物体碰撞”（54%对 17%，<0.001），涉及“偏离直线路径”机制（48%对 10%，<0.001）。在所有 71 起 SRC 中，与局灶性癫痫发作相比，全身性癫痫发作的司机年龄更小（<0.001），引发癫痫发作的因素更多（=0.033），并且发生在一天的早些时候（=0.004）。
结论
鉴于 SRC 具有独特的特征，我们建议临床医生、碰撞调查员和驾驶执照管理局将碰撞特征纳入对疑似 SRC 的整体评估中。进一步的研究应研究限制在风险期后立即驾驶作为一种减少伤害的策略。
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