Risk of Injury-Related Hospitalization Greater in Children With Epilepsy

Risk for injuries requiring hospitalization is greater among children with epilepsy, with fracture serving as the most common cause. Findings were published in Epilepsy & Behavior Reports.

With an estimated prevalence of 4.5 to 5.0 per 1000 European children and adolescents, epilepsy is the fourth most common neurological disorder worldwide. Children with epilepsy have been shown to be injured more often than those without the condition, including risk of fractures, burns, medicinal poisonings, and drowning deaths.

“However, systematic data analyzing all injury types in children with epilepsy and the effect of the type of epilepsy on injury risk are few and controversial,” noted the researchers of this study.

They conducted a retrospective study of 5 nationwide registers in Finland to further assess the incidence of hospital-treated injury in children with epilepsy, with targeted analyses performed on the type of epilepsy and the type of injury, in comparison with matched controls:

• The Finnish Central Population Register was used to identify the participants
• The Finnish Medical Birth Register was used to collect data on the mother’s socioeconomic status (SES) at delivery, delivery history, course of pregnancy, and perinatal events up to 1 week of age
• The Finnish Register of Congenital Malformations was used to collect data on congenital malformations
• The Finnish Hospital Discharge Register was used to identify children having epilepsy, other neurodevelopmental and neurodegenerative diseases, injuries, and hospital treatment periods
• Data on deaths were collected from the Causes of Death Register
  

For the study, all first-born singleton children (N = 133,055) born between January 1, 2001, and December 31, 2006, in Finland were included, with data collected from the national registers up to the first hospital-treated injury during the 5 years following the onset of epilepsy. Four matched controls were chosen for every subject.

“Epilepsy was first analyzed in a univariate model. The multivariable models included epilepsy, sex, categorized age, and maternal SES. In addition, univariate models including background variables (sex, categorized age and maternal SES) in assessing the risk for any injury were performed for all children and for children with epilepsy,” explained the researchers.

Of the study cohort, epilepsy was diagnosed in 0.66% (n = 884) of subjects (0.63% of females and 0.70% of males) and in none of the 3536 matched controls. Among the subjects, the mean (SD) age at epilepsy diagnosis was 5.4 (3.5) years, mean (SD) time from epilepsy diagnosis to the first hospital-treated injury was 4.6 (1.2) years, and mean (SD) age at first hospital-treated injury was 6.8 (3.3) years.

Comparatively, for controls, mean (SD) time from the start of follow-up to the first hospital-treated injury was 4.7 (0.9) years and mean (SD) age at first hospital-treated injury was 7.2 (3.2) years.

In findings of the univariate analyses among all included children (subjects and controls), male sex (P = .0057) and age at the start of the follow-up were associated with injury risk (P = .0002), but not maternal SES (P = .3689). Children aged 10-13 years at the start of the follow up were at significantly lower risk than 0- to 2-year-olds for injuries (HR, 0.567; 95% CI, 0.377-0.853; P = .0064), while other age groups did not significantly differ from the reference.

For solely children with epilepsy, neither sex (P = 0.4393), categorized age at the start of the follow-up (P = 0.1678), nor maternal SES (P = 0.4518) were significantly associated with the risk of hospital-treated injury.

During follow-up, children with epilepsy were shown to be more likely than controls to be hospitalized for injuries (12% vs 9%) in both univariate (HR, 1.387; 95% CI, 1.115-1.725; P = .0033) and multivariable analyses (HR, 1.344; 95% CI, 1.064-1.700; P = .0133).

The most common body regions of injuries leading to hospital care were extremities (7.0% of those with epilepsy and 5.0% of controls) and head and neck region (3.4% and 2.7%, respectively). Fractures were the most common type of injury leading to hospital treatment in both groups.

No significant difference was observed regarding the nature of injury or survival risk between subjects and controls. Findings also showed no difference in the rate of hospitalization according to the type of epilepsy.

The study’s retrospective design, inclusion of only hospital-treated patients, and failure to analyze effects of antiseizure medication on injuries and fractures in the patients were cited as limitations of the findings.

“While the spectrum of injuries is similar in children with and without epilepsy, children with epilepsy may be more prone to head injuries,” concluded the study authors. “Individual preventive measures, such as using a helmet and showering in a nonglass cubicle rather than taking a bath, is recommendable especially in difficult-to-treat epilepsies.”

Reference

Ripatti L, Puustinen L, Rautava P, Koivisto M, Haataja L. Impact of epilepsy on the risk of hospital-treated injuries in Finnish children. Epilepsy Behav Rep. Published online January 16, 2023. doi:10.1016/j.ebr.2023.100587