Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
Health Data Science, University of Liverpool, Liverpool, UK.
BMJ Open. 2024 Nov 13;14(11):e089126. doi: 10.1136/bmjopen-2024-089126.
With a projected rise in care home residency and the disproportionate impact of epilepsy and seizures on older adults, understanding seizure-related needs in this population is crucial. Data silos and inconsistent recording of residence status make this challenging. We thus leveraged ambulance data to investigate seizure call-out incidence, characteristics, management and costs in care homes compared with the wider community.
Retrospective analysis of dispatch data from a regional English ambulance service over four 9-month periods between 2014/2015 and 2021/2022. Suspected seizures in adults (≥16 years) were identified, with data on location, patient age, severity and management extracted. Incidence rates, trends over time and case characteristics were compared. Costs of ambulance response were estimated, and factors influencing emergency department (ED) conveyance were analysed using logistic regression.
North West Ambulance Service National Health Service Trust, serving an adult population of ~5.5 million.
Dispatch data for 98 752 suspected seizure cases.
Care homes, accommodating ~0.8% of the regional population, accounted for 7.2% of seizure call-outs. Incidence was higher in care homes than the wider community (55.71 vs 5.97 per 1000 person/year in 2021/2022) and increased over time. Care home cases peaked around 8:00-9:00. Despite similar or lower severity, they had a higher ED conveyance rate (78.3% vs 70.6%). Conveyance likelihood was influenced by factors beyond severity: reduced in homes specialising in learning disabilities (adjusted OR=0.649) and increased in homes with nursing provision (adjusted OR=1.226). Care homes accounted for 7.26% of the £24 million cost.
This study highlights the growing seizure-related needs in care homes. Despite similar severity, most cases result in ED conveyance. Future research should examine the appropriateness and implications of these transfers, ensuring specialist services support the care home population effectively.
随着养老院居住人数的预计增加以及癫痫和发作对老年人的不成比例影响，了解这一人群的与发作相关的需求至关重要。数据孤岛和居住状况记录的不一致使得这一点具有挑战性。因此，我们利用救护车数据调查了养老院与更广泛社区相比，发作呼叫的发生率、特征、管理和成本。6
对 2014/2015 年至 2021/2022 年四个 9 个月期间英格兰地区救护车服务的调度数据进行回顾性分析。确定了成年人（≥16 岁）疑似癫痫发作的病例，并提取了位置、患者年龄、严重程度和管理的数据。比较了发病率、随时间的趋势和病例特征。估计了救护车反应的成本，并使用逻辑回归分析了影响急诊室（ED）转运的因素。
西北救护车服务国民保健服务信托基金，为约 550 万成年人提供服务。
98752 例疑似癫痫发作的调度数据。
容纳约 0.8%区域人口的养老院占癫痫发作呼叫的 7.2%。与更广泛的社区相比，养老院的发病率更高（2021/2022 年为 55.71 比 5.97/1000 人/年），且呈上升趋势。养老院的病例高峰在 8:00-9:00 左右。尽管严重程度相似或较低，但它们的 ED 转运率更高（78.3%比 70.6%）。转运的可能性受到严重程度以外因素的影响：在专门收治学习障碍的养老院中降低（调整后的 OR=0.649），在有护理服务的养老院中增加（调整后的 OR=1.226）。养老院占 2400 万英镑成本的 7.26%。
本研究强调了养老院中不断增长的与发作相关的需求。尽管严重程度相似，但大多数病例都需要 ED 转运。未来的研究应检查这些转移的适当性和影响，确保专科服务能够有效地为养老院人群提供支持。
