Abstracts

Rationale: Epilepsy is associated with an increased risk for mortality at all ages compared to the general population, but this risk in children varies substantially. Child Death Review Programs exist in U.S. states and some jurisdictions to identify child death events and their risk factors to prevent these deaths. The goal of this study was to investigate cause-specific mortality in children and young adults with epilepsy based on the U.S. National Child Death Review case reporting system (NCDR-CRS). Methods: NCDR-CRS is a web-based, passive epidemiologic surveillance system supported voluntarily in 43 states. It includes a comprehensive review of case records from multiple community sources to provide child death review teams a method for capturing, analyzing, and reporting child deaths and their causes. A total of 49,586 deaths in children and young adults aged 28 days to 24 years (36% under 1 year old and 53% under 5 years old) was collected from 2004-2012 in 32 states reporting to NCDR-CRS. Epilepsy cases were identified by several epilepsy-related questions on the NCDR-CRS form. We identified 789 deaths with epilepsy (excluding acute symptomatic seizures and status epilepticus) and 48,146 deaths without epilepsy. The proportionate mortality was compared between these two groups. Results: Persons with epilepsy had significant higher percentage of natural death and lower accident death than persons without epilepsy: 75.79 % (95% CI=72.36-79.23) versus 34.90 % (95% CI=34.18-35.62) and 11.15 % (95% CI=4.58-17.73) versus 34.36 % (95% CI=33.64-35.09), respectively (p<0.05); By the primary causes of death, comparing to the persons without epilepsy, persons with epilepsy have significant higher percentage of other medical condition related death: 26.36 %(95% CI=20.37-32.35) versus 7.67 %(95% CI=6.81-8.53) (p<0.05) and pneumonia related death: 6.08 %(95% CI=0.00-12.58) versus 2.56 %(95% CI=1.68-3.44)(p<0.05). In addition, persons with epilepsy have significant lower percentage of motor vehicle injury death than persons without epilepsy: 0.89 %(95% CI=0.00-7.83) versus 17.14 %(95% CI=16.33-17.96)(p<0.05). Conclusions: Since no similar comparable publication has reported on cause -specific proportionate mortality in children and young adults with and without epilepsy, the NCDR-CRS provides unique additional information based on multiple state-based data. Despite the limitations of the NCDR-CRS such as data being reported from only 32 states, biases in case-ascertainment, and few epilepsy cases, this study indicates a higher percentage of mortality for natural, medical conditions (including pneumonia) but lower percentage of mortality for motor vehicle deaths in those with epilepsy, similar to findings reported from other studies of those with epilepsy. The lower percentage of mortality in accident-associated death in those with epilepsy merits further investigation. The NCDR database might help identify risk and protective factors in epilepsy-associated deaths in children and young adults. Source of founding: N/A