Ocena powodzenia przejścia pacjentów z pediatrycznych do dorosłych poradni epilepsji i jego związek z wynikami leczenia napadów - badanie kohortowe z Wielkiej Brytanii
Measuring transition success from paediatric to adult epilepsy services and its association with seizure outcomes: a UK retrospective cohort study
W skrócie
Badacze opracowali narzędzie do mierzenia, czy przejście młodych pacjentów z epilepsją ze specjalistycznej opieki pediatrycznej do opieki dla dorosłych przebiegło pomyślnie. Wykazali, że prawidłowe przejście między poradniami wiąże się z lepszymi wynikami leczenia - pacjenci, którzy przeszli ten proces systematycznie, mieli czterokrotnie wyższe szanse na poprawę lub brak napadów w wieku 20 lat. Badanie sugeruje, że dobrze zorganizowany przeskok do dorosłej poradni naprawdę ma znaczenie dla zdrowia młodych pacjentów z epilepsją.
Oryginalny abstract (angielski)
OBJECTIVES: To develop a working definition of successful transition from paediatric to adult epilepsy services, assess transition success, identify predictors and determine whether success is associated with improved seizure outcomes in early adulthood. DESIGN: Retrospective cohort study. SETTING: Paediatric and adult epilepsy services in London, UK. PARTICIPANTS: Patients aged 20-24 with epilepsy in the paediatric service database (2009-2023) who transitioned to adult care. DEMOGRAPHICS: Date of birth, sex, ethnicity. EXPOSURES: Age at first documented paediatric epilepsy clinical appointment (this is not age of epilepsy onset) and number of epilepsy-related comorbidities at age 17. TRANSITION MEASURE: Success was defined by four criteria: developmentally appropriate initiation, comprehensive preparation using National Institute for Health and Care Excellence guidance, attendance at joint paediatric/adult transition clinic and adult follow-up within 6 months of transition clinic. MAIN OUTCOME MEASURE: Change in seizure frequency between ages 17 and 20. RESULTS: Of 59 eligible patients, 72.9% (43/59) achieved successful transition. Criteria were well-met: initiation (91.5%), preparation (91.5%), joint clinic (79.7%) and follow-up (88.1%). Successful transition increased the odds of seizure improvement/remaining seizure-free (adjusted OR 4.28, 95% CI 1.07 to 17.19) after adjusting for: age at first paediatric epilepsy clinical appointment, sex, ethnicity and comorbidities. Males had higher odds of seizure improvement/remaining seizure free than females (adjusted OR 4.29, 95% CI 1.26 to 14.67).No significant association was seen with ethnicity or age at first appointment. CONCLUSIONS: A novel transition success tool was developed. Larger, multicentre studies are needed to validate this tool and confirm associations with long-term outcomes.