gms | German Medical Science

Background and status of (inter)national research: Epilepsy is a common and challenging neurological disorder characterized by recurring epileptic seizures. In most cases seizures are self-limiting; emergencies may include seizures of longer duration (prolonged seizures, status epilepticus) or series of several seizures (seizure clusters), and account for 1–3% of all emergency department visits in children and adults worldwide [1], [2], [3], [4]. A patient experiencing a first seizure is a common reason to call an emergency medical service (EMS), and in many cases the seizure occurs as part of an underlying epileptic syndrome.

Research question and objective: There is a need to understand the current situation around ambulance service utilization by patients with seizures. Therefore, the aim of this study was to characterise and analyse the number of seizure-related emergency cases in Germany.

Method or hypothesis: A retrospective analysis was performed using data from Germany’s EMS tracking and reporting system database in the federal state of Hesse. All patients with suspected seizures who required ambulance services from 1 January 2019 through 31 December 2019 were analysed. We identified patients with seizures using three data codes based on indication codes (Rückmeldeindikationen, RMIs): RMI 411 (seizure with known seizure disorder), RMI 412 (first seizure) and RMI 514 (paediatric epilepsy).

Results: The database covered a total population of approximately 3.05 million persons, representing approximately 48% of the total population in Hesse. A total of 6264 cases with a mean age of 44.5 (standard deviation [SD] 23.4) years were included in the final analysis. The total (all age groups) incidence of seizure cases per 100,000 inhabitants was 205.7 (95% confidence interval [95% CI]: 200.7, 210.9) (RMI 411: 135.4 [95% CI: 131.3, 139.6] / RMI 412: 63.2 [95% CI: 60.4, 66.1] / RMI 514: 7.2 [95% CI: 6.2, 8.2]). The highest case incidence per 100,000 inhabitants for RMI 411 was calculated for age group 18–44 years (175.4 [95% CI: 167.5, 183.5]), for RMI 412 in age group 65+ years (103.6 [95% CI: 95.6, 112.1]) and for RMI 514 for children aged 0–3 years (86.0 [95% CI: 70.5, 103.8]), respectively. Hospital admissions based on coded urgency assessments (Patientenzuweisungscode, PZC) were priority 2 (inpatient treated) for 74.1% of all patient cases (RMI 411: 70.7% / RMI 412: 80.9% / RMI 514: 78.0%), followed by priority 0 (no transportation; 13.2%), and priority 1 (immediate intervention needed; 9.7%). None of the included cases received a coding for fatal outcomes in the prehospital setting (555 for the first three RMC digits). Median time from call to arrival at site was 6 min 44 sec (IQR 4 min 43 sec) and from call to arrival at hospital was 44 min 48 sec (IQR 19 min 29 sec).

Discussion: The results of this analysis indicate high incidences of seizures requiring ambulance services and most of those instances led to hospitalisation of patients.

Funding: Sonstige Förderung; UCB Pharma gesponsort