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Acute encephalopathy and seizure rates in children under age two years in Oregon and Washington state
J K Bobo1, P B Thapa, J R Anderson
1Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha 68198-4350.
Insights
A surveillance network identified childhood neurologic illnesses in Oregon and Washington. Capture-recapture analysis estimated 80% detection, highlighting under-ascertainment for afebrile seizures.
Area of Science:
- Pediatric Neurology
- Epidemiology
- Public Health Surveillance
Background:
- Childhood neurologic illnesses require accurate incidence data for effective public health planning.
- Establishing comprehensive surveillance is crucial for understanding disease burden in young children.
- Previous studies may have underestimated the true incidence of these conditions due to ascertainment challenges.
Purpose of the Study:
- To establish a surveillance network for specific neurologic illnesses in children aged 1-24 months in Oregon and Washington.
- To determine observed case occurrence rates for encephalopathies, infantile spasms, afebrile seizures, and complex febrile seizures.
- To utilize capture-recapture analysis to estimate the completeness of case ascertainment and predict true incidence rates.
Main Methods:
- A multi-component surveillance network was implemented, including hospitals, pediatricians, neurologists, and record abstractors.
- Data were collected over a one-year period (August 1, 1987, to July 31, 1988).
- Capture-recapture analysis with log-linear modeling was employed to estimate the proportion of detected cases and adjust for under-ascertainment.
Main Results:
- A total of 626 qualifying cases were identified from 3,876 potential reports.
- Observed incidence rates per 100,000 children were: encephalopathies (16), infantile spasms (10), afebrile seizures (159), and complex febrile seizures (101).
- Capture-recapture analysis estimated 80% overall case detection, with significant under-ascertainment suggested for afebrile seizures (69% detected).
Conclusions:
- The study demonstrated the utility of a multi-component surveillance network for identifying childhood neurologic disorders.
- Capture-recapture analysis is a valuable tool for assessing surveillance completeness and estimating true disease incidence.
- Findings suggest that afebrile seizures may be more prevalent than previously estimated, warranting further investigation and improved surveillance strategies.
Abstract:
A surveillance network was established in Oregon and Washington state to identify cases of certain neurologic illnesses during a one-year period (August 1, 1987 to July 31, 1988) among children 1-24 months of age. Reported here are the observed case occurrence rates and findings from capture-recapture analyses used to predict rates that would have been observed had ascertainment been complete. The network consisted of a hospital component involving 98% of all eligible facilities, a provider component involving 93% of all eligible pediatricians and neurologists, and a research staff component of record abstractors. Of 3,876 potential cases reported, 626 met the study criteria. The observed rates for the primary diagnostic groups were: encephalopathies, 16 per 100,000 children; infantile spasms, 10 per 100,000 children; afebrile seizures, 159 per 100,000 children; and complex febrile seizures, 101 per 100,000 children. Of the 626 qualifying cases, 41% were reported by two or more surveillance components. Capture-recapture analyses with log-linear modeling to control for source dependence suggested 80% of all study cases were detected. Comparable percentages for the four illness groups were: encephalopathies, 82%; infantile spasms, 94%; afebrile seizures, 69%; and complex febrile seizures, 91%. The predicted rate for afebrile seizures, corrected for under-ascertainment, exceeded the upper 95% confidence interval bound around the observed rate. For all other conditions, predicted rates fell within the 95% confidence intervals around the observed rates. These findings suggest capture-recapture analyses should be applied to the full sample of cases and to relevant disease substrata.