Disparities in hospital outcomes for injured people with epilepsy/seizures

作者：Bowman Stephen M^*; Aitken Mary E; Sharp Gregory B

来源：Epilepsia, 2010, 51(5): 862-867.

DOI：10.1111/j.1528-1167.2009.02492.x

• Injury
• Epilepsy
• Seizures
• Disparities
• Hospitalizations
• Outcomes

P>Purpose:
Controlling for injury and patient characteristics, one would expect comparable in-hospital outcomes for injured patients with and without epilepsy. The historical stigma associated with epilepsy is well-documented, yet potential disparities in injury care for people with epilepsy/seizures have not been examined. We compared in-hospital outcomes of injured patients with epilepsy/seizures with patients without epilepsy/seizures and tested the hypothesis that injured people with epilepsy have worse outcomes.
Methods:
Existing data were analyzed from the Nationwide Inpatient Sample-the largest, longitudinal, all-payer inpatient care database in the United States. Injured patients of all ages were included. Multivariable logistic regression was used to control for patient and hospital characteristics. Main outcome measure: in-hospital mortality.
Results:
When controlling for patient and injury characteristics, our results show that people with epilepsy/seizures were more likely to die in-hospital than people without epilepsy [odds ratio (OR) 1.17, p < 0.001]. People with epilepsy were significantly more likely to have a traumatic brain injury diagnosis than similar individuals without epilepsy (unintentional injuries OR 2.81, p < 0.001; interpersonal violence OR 6.0, p < 0.001). By mechanism of injury, significantly increased risk of death was observed for injuries from falls (OR 1.21, p < 0.001), other transport injuries (OR 2.04, p = 0.01), struck by/against (OR 1.85, p = 0.02), and suffocation (OR 10.93, p = 0.009). People with epilepsy/seizures receiving firearm injuries were less likely to die in-hospital (OR 0.25, p < 0.001).
Discussion:
Disparities in hospital outcomes for people with epilepsy deserve further attention. Identifying the underlying causes of these disparities will allow for the development of targeted prevention interventions.

• 出版日期2010-5