Emergency department management of patients with seizures: A multicenter study

Objectives: Patients with seizure disorders are common in the emergency dep artment (ED) yet little is known regarding the management of these patients . This study was performed to define the frequency of patients with seizure disorders in the ED patient population and to determine possible seizure e tiologies, characteristics of diagnostic activities, treatments, and dispos itions. Methods: Twelve EDs monitored all patients with a chief complaint r elated to seizure disorders presenting over 18.25 days (5% of the calender year) in late 1997. Retrospective chart review was used to gather specific data regarding these consecutive cases. Results: Of the 31,508 patients who presented to these 12 EDs during the study period, 368 (1.2%) had complain ts related to seizures. Three hundred sixty-two charts were available for a nalysis and make up the study population. Two hundred fifty-seven (71%) uti lized emergency medical services (EMS) for transport and care. Advanced car e, including intravenous access, laboratory work, cardiac monitoring, or ox ygen administration, was utilized in 304 (84%) patients. Antiepileptic drug s were given in 199 (55%) patients. Ethanol withdrawal or low antiepileptic drug levels were implicated as contributing factors in 177 (49%) of patien ts. New-onset seizures were thought to be present in 94 (26%) patients. Sta tus epilepticus occurred in only 21 (6%) patients. Ninety-eight (27%) of al l patients were admitted to the hospital. Conclusions: Patients with presen ting complaints related to seizures are frequent in the ED population and m ake considerable demands on EMS and ED resources. Six percent of patients w ith seizure-related presentations were in status epilepticus and more than a fourth of all patients required hospitalization.