Late Breaking News
- Categorized in: 2013 Compendium of Federal Medicine
We present yearly and five years combined data for fiscal years 2007 (Oct. 1, 2006-Sept. 30, 2007) - FY 2011 (Oct. 1, 2010-Sept. 30, 2011) to describe trends of VA seizures and spells patients among TBI and PTSD patients. Additionally, prevalence estimates of spells among TBI and PTSD patients are provided.
Methods: The Veterans Service Support Center VHA administrative databases were used to extract counts of unique patients using International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) 11 diagnoses codes. In order to assess more accurate counts of patients served by VHA all source files (VA Outpatient, VA Inpatient, Fee basis Outpatient and Fee basis Inpatient) were included. Patients with a particular disease were identified by ICD-9-CM diagnoses codes in primary or secondary positions. TBI diagnosis codes were adopted from TBI case definition of Armed Force Health Surveillance Center (AFHSC) consistent with DOD Standard Surveillance case definition of TBI.12 PTSD patients were identified by ICD-09-CM 309.81. To assess counts of seizures/spells patients ICD-09-CM 345.xx (epilepsy), 780.3x (convulsions), 649.4x (epilepsy codes used in pregnant women) were used. Numbers of unique patients were captured by removing duplicates, counting patients once despite multiple diagnoses in seizure group. For example patients with both diagnoses of 345.91 (epilepsy, unspecified, with intractable epilepsy) and 780.39 (other convulsions) in a particular fiscal year were counted only once in the seizure group. Parent Station (primary facility) of care was used to assess the ECoE workload.
Results: Figure 2a represents the yearly counts of seizure patients seen in the VA along with ECoE counts. It shows that the seizure population in the VA as well as among ECoEs is increasing, yet the percentage of patients seen in the ECoEs (approximately 19%) is generally consistent.
Figure 2b and Figure 2c illustrate yearly counts of TBI and PTSD patients who also experienced spells in the VA as well as those enrolled in the ECoEs. Figure shows increasing numbers of seizure patients among TBI and PTSD cohorts. According to the data, the ECoE program in its infancy is serving approximately 21% of TBI patients with spells and 20% of PTSD patients with spells.
Table 1a presents the yearly counts of TBI and PTSD patients served in the VA from FY 2007 - FY 2011. Combined numbers of patients seen between FY 2007 - FY 2011 are included. Prevalence estimates of seizure/spells patients per 1,000 TBI or PTSD patients are included in Table 1b. These estimates are based upon numbers presented in Figure 2 and Table 1a. The yearly prevalence estimates show an alarming number of TBI and PTSD patients with seizures (approximately 114 per 1,000 TBI patients every year and 28 per 1,000 PTSD patients every year).
In the five-year time period FY 2007 - FY 2011, 26,781 TBI and 44,707 PTSD patients had spells. These statistics and Table 1a counts were used to calculate prevalence of seizures among TBI and PTSD patients for combined (FY 2007 - FY 2011) years. The prevalence of seizures among TBI patients based on five-year data is 140.2 per 1,000 patients; and for PTSD patients prevalence estimates are 48.5 per 1,000 patients. The prevalence of seizures among TBI patients is almost three times the prevalence among PTSD patients.
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