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Trends in epilepsy admissions in children, 1981–2013: population-based observational study using the Scottish national hospital discharge database
  1. Richard F M Chin1,2,
  2. Jacqueline Stephen3,
  3. Christopher J Weir1,3,
  4. Rachael Wood1,4
  1. 1 Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK
  2. 2 Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
  3. 3 Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  4. 4 Information Services Division, NHS National Services Scotland, Edinburgh, UK
  1. Correspondence to Dr Richard F M Chin, Muir Maxwell Epilepsy Centre, Child Life and Health, University of Edinburgh, Edinburgh EH9 1UW, UK; r.chin{at}ed.ac.uk

Abstract

Objective To examine trends in epilepsy admissions in children from 1981 to 2013.

Design Repeated cross-sectional, population-based study.

Setting Scotland.

Patients We identified admissions among children between 1981 and 2013 inclusive. Epilepsy admissions were identified from the Scottish national hospital discharge database by using relevant diagnostic codes. Primary epilepsy admissions (PEAs) were those with epilepsy as the primary discharge diagnosis, or convulsions as the primary diagnosis but with epilepsy as secondary diagnosis. All other epilepsy admissions were secondary epilepsy admissions (SEAs).

Main outcome measures Trends in annual epilepsy and non-epilepsy admission rates, as well as sociodemographic, clinical characteristics, length of stay and readmissions of epilepsy admissions.

Results 57 031 epilepsy and 3 863 809 non-epilepsy admissions were available for analysis. Overall, epilepsy and non-epilepsy admissions increased, with a greater increase in epilepsy admissions (interaction Χ2 test statistic 252, p<0.00001). Elective epilepsy admissions, unlike elective non-epilepsy admissions, continually increased, but emergency epilepsy admissions increased until 2000 and showed only minor fluctuations thereafter. Increase in SEAs was more marked than PEAs (interaction Χ2 test statistic 627, p<0.0001). 48% of epilepsy admissions were to children’s hospitals. No substantial trends were apparent in age, gender or deprivation distribution of epilepsy admissions. There was a clear trend towards shorter length of stay.

Conclusions Childhood epilepsy admissions are increasing, at a faster rate than non-epilepsy admissions, and have changed towards shorter, more elective admissions. Many will not be to children’s hospitals, and the primary reason will often not be because of epilepsy/convulsions. More, not less, epilepsy resources are needed.

  • trends
  • epilepsy
  • admissions
  • children
  • population-based

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Footnotes

  • Contributors RFMC conceptualised the study. RFMC, CJW and RW designed the study. RFMC, CJW and RW obtained regulatory approvals. JS extracted the data. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the writing of the manuscript and have approved the final version submitted for publication.

  • Funding The study was funded by the Muir Maxwell Trust. CJW was supported in this work by NHS Lothian via the Edinburgh Clinical Trials Unit. The funders had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

  • Competing interests The study was funded by the Muir Maxwell Trust, which has provided financial support to help establish the Muir Maxwell Epilepsy Centre at the University of Edinburgh.

  • Patient consent Not required.

  • Ethics approval We obtained governance approval in April 2014 from the Privacy Advisory Committee (PAC 35/13, now the Public Benefit and Privacy Panel,23 http://www.informationgovernance.scot.nhs.uk/pbpphsc/). The East of Scotland Research Ethics Service confirmed in April 2014 ethical approval was not required (CYA/AG/14/GA/0047). Analyses were undertaken within the NHS Scotland Safe Haven.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used in this project are controlled by NHS National Services Scotland. Other researchers wishing to access anonymised, patient-level data for research purposes should contact NSS’s research support team, eDRIS (see http://www.isdscotland.org/Products-and-Services/eDRIS/).

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