Pallin 2008
Year: 2008
Title: Seizure visits in US emergency departments: epidemiology and potential disparities in care
Country: United States
Age: All Ages
Sex: All Sexes
Population: Multiple Groups
Care Setting: Emergency Department
Clinical Setting: Neurologic
Data Level: National
Data Type: Government Survey
Data Source: National Hospital Ambulatory Medical Care Survey
Conclusion: Disparities In All Minority Groups
Health OutComes Reported: No
Mitigation: No
Free Text Conclusion: Minorities less likely to get neuroimaging for seizure visits to EDs.
Abstract: Introduction: While epilepsy is a well-characterized disease, the majority of emergency department (ED) visits for "seizure" involve patients without known epilepsy. The epidemiology of seizure presentations and national patterns of management are unclear. The aim of this investigation was to characterize ED visits for seizure in a large representative US sample and investigate any potential impact of race or ethnicity on management. Methods: Seizure visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1993 to 2003 were analysed. Demographic factors associated with presentation, neuroimaging and hospital admission in the USA were analysed using controlled multivariate logistic regression. Results: Seizure accounts for 1 million ED visits annually [95% confidence interval (CI): 926,000-1,040,000], or 1% of all ED visits in the USA. Visits were most common among infants, at 8.0 per 1,000 population (95% CI: 6.0-10.0), and children aged 1-5 years (7.4; 95% CI: 6.4-8.4). Seizure was more likely among those with alcohol-related visits [odds ratio (OR): 3.2; 95% CI: 2.7-3.9], males (OR: 1.4; 95% CI: 1.3-1.5) and Blacks (OR: 1.4; 95% CI: 1.3-1.6). Neuroimaging was used less in Blacks than Whites (OR: 0.6; 95% CI: 0.4-0.8) and less in Hispanics than non-Hispanics (OR: 0.6; 95% CI: 0.4-0.9). Neuroimaging was used less among patients with Medicare (OR: 0.4; 95% CI: 0.2-0.6) or Medicaid (OR: 0.5; 95% CI: 0.4-0.7) vs private insurance and less in proprietary hospitals. Hospital admission was less likely for Blacks vs Whites (OR: 0.6; 95% CI: 0.4-0.8). Conclusion: Seizures account for 1% of ED visits (1 million annually). Seizure accounts for higher proportions of ED visits among infants and toddlers, males and Blacks. Racial/ethnic disparities in neuroimaging and hospital admission merit further investigation.