Cross-sectional study of the hospital management of adult patients with a suspected seizure (EPIC2)
Dickson, Jon M. Dudhill, Hannah Shewan, Jane Mason, Suzanne Grünewald, Richard A. Reuber, Markus
Dickson, Jon M.
Dudhill, Hannah
Shewan, Jane
Mason, Suzanne
Grünewald, Richard A.
Reuber, Markus
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Abstract
Objective To determine the clinical characteristics,
management and outcomes of patients taken to hospital
by emergency ambulance after a suspected seizure.
Design Quantitative cross-sectional retrospective study of
a consecutive series of patients.
Setting An acute hospital trust in a large city in England.
Participants In 2012–2013, the regions’ ambulance
service managed 605 481 emergency incidents,
74 141/605 481 originated from Sheffield (a large city in
the region), 2121/74 141 (2.9%) were suspected seizures
and 178/2121 occurred in May 2012. We undertook
detailed analysis of the medical records of the 91/178
patients who were transported to the city’s acute hospital.
After undertaking a retrospective review of the medical
records, the best available aetiological explanation for the
seizures was determined.
Results The best available aetiological explanation for
74.7% (68/91) of the incidents was an epileptic seizure,
11.0% (10/91) were psychogenic non-epileptic seizures
and 9.9% (9/91) were cardiogenic events. The epileptic
seizures fall into the following four categories: first
epileptic seizure (13.2%, 12/91), epileptic seizure with a
historical diagnosis of epilepsy (30.8%, 28/91), recurrent
epileptic seizures without a historical diagnosis of epilepsy
(20.9%, 19/91) and acute symptomatic seizures (9.9%,
9/91). Of those with seizures (excluding cardiogenic
events), 2.4% (2/82) of patients were seizing on arrival
in the Emergency Department (ED), 19.5% (16/82) were
postictal and 69.5% (57/82) were alert. 63.4% (52/82)
were discharged at the end of their ED attendance and
36.5% (19/52) of these had no referral or follow-up.
Conclusions Most suspected seizures are epileptic
seizures but this is a diagnostically heterogeneous group.
Only a small minority of patients require emergency
medical care but most are transported to hospital. Few
patients receive expert review and many are discharged
home without referral to a specialist leaving them at risk
of further seizures and the associated morbidity, mortality
and health services costs of poorly controlled epilepsy
https://bmjopen.bmj.com/content/bmjopen/7/7/e015696.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2016-015696