Which factors are associated with hospitalisation in people presenting with convulsions to ambulance services: cross sectional study using ambulance and hospital linked data.

Asghar, Zahid and Smith, Murray and Dickson, Jon and Miller, Philip and Coffey, Frank and Siriwardena, Niro (2019) Which factors are associated with hospitalisation in people presenting with convulsions to ambulance services: cross sectional study using ambulance and hospital linked data. In: Regional Trent SAPC, 19th March 2019, University of Nottingham.

Documents
Which factors are associated with hospitalisation in people presenting with convulsions to ambulance services: cross sectional study using ambulance and hospital linked data.
Poster
[img]
[Download]
[img] PDF
SAPC_2019_seizures_final.pdf - Whole Document

794kB
Item Type:Conference or Workshop contribution (Poster)
Item Status:Live Archive

Abstract

Introduction
Patients with convulsions presenting to ambulance services are not always hospitalised. We aimed to investigate which factors are associated with hospitalisation in this patient group.
Methods
We used a cross sectional design linking ambulance dispatch and clinical data with hospital Emergency Department and inpatient data from July 2016 to June 2017. We included adults aged 16 years or over with ambulance records including the terms ‘convulsion’ or ’fitting and hospital records confirming the diagnosis of convulsion. Descriptive statistics summarised available data for ambulance service processes, ambulance response times, demographic data, clinical (physiological) findings summarised as NEWS2 (incorporating respiratory rate, oxygen saturation, systolic blood pressure, pulse arte, conscious level and temperature) and treatments. We will use logistic regression to construct models showing predictors of admission to hospital or intensive care unit (ICU). We used NHS reference costs to estimate costs of care.
Results
Of 1009 ambulance records of patients with convulsion 517 were adults aged 16 years or over with a hospital diagnosis of seizure. Overall, 221 of 517 (42.8%) were admitted, 113 (21.9%) for 1 day or less and the rest up to 7 days; 24 were admitted to the intensive care unit 17 for over 10 days and 6 for over 60 days totalling 1262 days. Older patients, particularly aged 65 years and over (OR 12.4, 95% CI 5.7 - 26.6, P<0.01) compared with younger patients aged 16-25 years, male patients (OR 1.9, 95%CI 1.3 - 2.9, P<0.01) compared with females and those with NEWS2 score 3 compared with zero (OR 2.1, 95%CI 1.2 - 3.5, P<0.01) were more likely to be admitted to hospital. Older patients aged 65 years and over (OR 10.4, 95% CI 1.8 - 60.7, P<0.01) compared with those aged 16-25 years and those with NEWS2 score 3 compared with zero (OR 8.2, 95%CI 2.5 - 27.4, P<0.01) were more likely to be admitted to ICU.
Conclusion
Most patients with convulsions are not admitted to hospital. Older patients with more disturbed physiological measures are more likely to be admitted to intensive care and these and male patients are also more likely to be hospitalised.

Keywords:Convulsions and seizures, Prehospital, Electronic patient data, hospital admissions, linked HES data
Subjects:L Social studies > L510 Health & Welfare
A Medicine and Dentistry > A300 Clinical Medicine
B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
Divisions:College of Social Science > School of Health & Social Care
ID Code:36326
Deposited On:28 Jun 2019 09:42

Repository Staff Only: item control page