Hamamatsu University School of Medicine, Shizuoka, Japan.
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
PLoS One. 2023 Aug 29;18(8):e0290783. doi: 10.1371/journal.pone.0290783. eCollection 2023.
To prioritize emergency medical calls for ambulance transport for patients with suspected seizures, information about whether the event is their 1st or non-1st seizure is important. However, little is known about the difference between 1st and non-1st seizures in terms of severity. We hypothesized that patients transferred multiple times (≥2 times) would represent a milder scenario than patients on their first transfer. The purpose of this study was to compare patients with suspected seizures on 1st transfer by ambulance and patients who had been transferred ≥2 times.
We statistically compared severity of suspected seizures between two groups of patients with suspected seizures transferred between December 2014 and November 2019 (before the coronavirus disease 2019 pandemic) to our facility by ambulance for either the first time (1st Group) or at least the second time (Non-1st Group). Severity categories were defined as: Level 1 = life-threatening; Level 2 = emergent, needing admission to the intensive care unit; Level 3 = urgent, needing admission to a hospital general ward; Level 4 = less urgent, needing intervention but not hospitalization; and Level 5 = non-urgent, not needing intervention.
Among 5996 patients with suspected seizures conveyed to the emergency department by ambulance a total of 14,263 times during the study period, 1222 times (8.6%) and 636 patients (11%) met the criteria. Severity grade of suspected seizures ranged from 1 to 5 (median, 4; interquartile range, 3-4) for the 1st Group and from 1 to 5 (median, 5; interquartile range, 4-5) for the Non-1st Group. Most severe grade ranged from 1 to 5 (median, 4; interquartile range, 4-5) for the Non-1st Group. Severity grade differed significantly between groups (p < 0.001, Mann-Whitney U-test). Uni- and multivariate logistic regression tests also suggested a significant difference (p < 0.001) in severity grades.
In direct comparisons, grade of suspected seizure severity was lower in the Non-1st Group than in the 1st Group.
为了优先为疑似癫痫发作的患者安排救护车转运，了解事件是否为首次发作或非首次发作的相关信息非常重要。然而，关于首次发作和非首次发作的严重程度，我们知之甚少。我们假设，多次（≥2 次）转运的患者代表了比首次转运的患者更轻微的情况。本研究的目的是比较首次通过救护车转运的疑似癫痫发作患者和至少转运 2 次的疑似癫痫发作患者。
我们对 2014 年 12 月至 2019 年 11 月（新冠疫情前）期间因疑似癫痫发作由救护车转运至我院的两组患者进行了统计学比较。一组为首次转运（第 1 组），另一组为至少转运 2 次（非首次转运组）。严重程度分类为：1 级=危及生命；2 级=紧急，需要入住重症监护病房；3 级=紧急，需要入住医院普通病房；4 级=不紧急，需要干预但不需要住院；5 级=不紧急，不需要干预。
在研究期间，共有 5996 例疑似癫痫发作患者通过救护车共转运 14263 次，其中 1222 次（8.6%）和 636 例（11%）符合标准。第 1 组疑似癫痫发作的严重程度等级为 1-5（中位数，4；四分位间距，3-4），非首次组为 1-5（中位数，5；四分位间距，4-5）。最严重的等级为 1-5（中位数，4；四分位间距，4-5），非首次组。两组间严重程度等级差异有统计学意义（p<0.001，Mann-Whitney U 检验）。单因素和多因素逻辑回归检验也表明严重程度等级存在显著差异（p<0.001）。
在直接比较中，非首次组疑似癫痫发作严重程度低于首次组。
