392 - First Time Non-Provoked Seizure Decision Analysis

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 392
Publication Number: 392.406

Lauren Tanaka, University of Hawaii, John A. Burns School of Medicine, Mililani, HI, United States; Loren Yamamoto, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States

Presenting Author(s)

Ayush Sidde Gowda, MD

Resident Physician
University of Hawaii

First Author(s)

LT

Lauren Tanaka, n/a

University of Hawaii, John A. Burns School of Medicine
Mililani, Hawaii, United States

Background: The majority of the patients who present to the Emergency Department (ED) with a first time non-provoked seizures are hospitalized for further evaluation.

Objective: Obtaining an EEG and MRI brain scan in the ED has not been widely studied but could prove to be a more timely and efficient means to complete this evaluation.

Design/Methods: A retrospective chart review was performed for all patients presenting to the ED with a first time non-provoked seizure from January 2014 through May 2022. 204 patients were included in the study and an evaluation work score was calculated for each patient (physician visits, ED/inpatient days, imaging/EEG studies, sedation) for those who received a full evaluation (EEG, brain imaging, decision to start anticonvulsants) in hospitalized patients, ED patients (all elements completed in ED), and outpatient (all elements completed in ED plus outpatient setting following ED discharge) patients.

Results:

Patients who received a full workup in the ED had the lowest evaluation work score (5.3) followed by those who received an outpatient workup (5.4) and inpatient workup (10.6) (p < 0.001). The outpatient workup took the longest to receive their necessary EEG (864 hours) and brain imaging (1430 hours). The ED workup strategy took the least amount of time to receive their EEG (3.6 hours) and brain imaging (3.1 hours) which yielded a faster anticonvulsant decision.

Conclusion(s):

The ED workup strategy had the lowest evaluation work score, requiring the least amount of aggregate resources and physician work. The ED also completed the necessary EEG, brain imaging, and anticonvulsant decisions sooner. The workup for a first time non-provoked seizure can be tedious, thus physicians should consider fully working up these patients in the ED.