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Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study.

ABSTRACT: AIMS:To quantify the frequency, characteristics, geographical variation and costs of emergency hospital care for suspected seizures. DESIGN:Cross-sectional study using routinely collected data (Hospital Episode Statistics). SETTING:The National Health Service in England 2007-2013. PARTICIPANTS:Adults who attended an emergency department (ED) or were admitted to hospital. RESULTS:In England (population 2011: 53.11?million, 41.77?million adults), suspected seizures gave rise to 50?111 unscheduled admissions per year among adults (?18 years). This is 47.1% of unscheduled admissions for neurological conditions and 0.71% of all unscheduled admissions. Only a small proportion of admissions for suspected seizures were coded as status epilepticus (3.5%) and there were a very small number of dissociative (non-epileptic) seizures. The median length of stay for each admission was 1?day, the median cost for each admission was £1651 ($2175) and the total cost of all admissions for suspected seizures in England was £88.2?million ($116.2?million) per year. 16.8% of patients had more than one admission per year. There was significant geographical variability in the rate of admissions corrected for population age and gender differences and some areas had rates of admission which were consistently higher than the average. CONCLUSIONS:Our data show that suspected seizures are the most common neurological cause of admissions to hospital in England, that readmissions are common and that there is significant geographical variability in admission rates. This variability has not previously been reported in the published literature. The cause of the geographical variation is unknown; important factors are likely to include prevalence, deprivation and clinical practice and these require further investigation. Dissociative seizures are not adequately diagnosed during ED attendances and hospital admissions.

SUBMITTER: Dickson JM

PROVIDER: S-EPMC6196871 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study.

Dickson Jon Mark JM Jacques Richard R Reuber Markus M Hick Julian J Campbell Mike J MJ Morley Rebeka R Grünewald Richard A RA

BMJ open 20181021 10

<h4>Aims</h4>To quantify the frequency, characteristics, geographical variation and costs of emergency hospital care for suspected seizures.<h4>Design</h4>Cross-sectional study using routinely collected data (Hospital Episode Statistics).<h4>Setting</h4>The National Health Service in England 2007-2013.<h4>Participants</h4>Adults who attended an emergency department (ED) or were admitted to hospital.<h4>Results</h4>In England (population 2011: 53.11 million, 41.77 million adults), suspected seizu ...[more]

PMID: 30344177

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Project description:ObjectivePrimary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation.MethodsWhole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003-2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors.ResultsOverall, standardised rates of PPCI increased from 0.01% to 86.3% (2003-2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1-5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences.ConclusionsFollowing an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care.

Dataset Information

Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study.

Publications

Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study.

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