Exploratory Cross-Sectional Study of Factors Associated with Transport to Hospital After A Suspected Convulsion or Seizure

Problem

hospital care is a key element of good quality care for these patients and it is a key determinant of downstream health service activity but there is very little research in this area. Epilepsy is an ambulatory care sensitive condition (ACSC) and the incidence of convulsions and seizures is an important indicator of failed scheduled care. The prevalence of active epilepsy in the UK is 1% and 20-30% of people with epilepsy have more than one seizure per month. Convulsions and seizures result in a large number of emergency calls to ambulance services, the majority of these patients are conveyed to emergency departments (ED), which accounts for much of the health costs of uncontrolled epilepsy.

Approach

We conducted a cross-sectional analysis of retrospective electronic clinical data for patients with suspected convulsions and seizures over a one year period (August 2011 to July 2012) extracted from a single regional ambulance service (EMAS). Our aims were firstly to generate descriptive statistics (including incidence) for patients over the age of 18 years treated by EMAS for seizures over a period of a year, and secondly to use regression analysis to identify predictors of transport to hospital in this sample.

Findings

There were 4,428 patients with chief complaint recorded as suspected convulsions or seizures over a period of one year with a substantial proportion 3.0% of ambulance calls of which 66.6% were transported to hospital. Suspected convulsions and seizures were the sixth most common reason for emergency calls to the East Midlands Ambulance Service. There were 2,449 (55.3%) male and 1,979 (44.7%) females among those suspected with suspected convulsions and seizures (χ2, p<0.01). Compared with calls for all other conditions, no ethnic differences in calls were found (χ2, p=0.58), but there were statistically significant differences in age, Index of Multiple Deprivation, AVPU and Glasgow Coma Scale (χ2, p<0.001). Preliminary findings from the regression analysis show that patients with suspected convulsions are more likely to be transported if they were older (p<0.001), had a lower heart rate (p<0.001) were not alert (p<0.001) or were administered diazepam (p=0.01). Preliminary findings from the regression analysis show that patients with suspected convulsions are more likely to be transported if they were older than 49 (p<0.001), had a lower heart rate (p<0.001) were not alert (p<0.001), call type was categorised as urgent or were administered diazepam (p=0.01).

Consequences

Suspected seizures are a common cause of presentation to ambulance services and transport to hospital varies with patient, clinical and treatment factors.