SeizED: Seizures in the Emergency Department (P7.029)

OBJECTIVE: We examined the current literature guidelines for the evaluation of seizures in the emergency department (ED) and analyzed the current practice for the evaluation of seizures in the ED at the University of Utah. We then used this information to create a suggested seizure evaluation pathway for new and known seizure disorders in the acute setting. BACKGROUND: Seizures represent 1[percnt] of all visits in the ED but there is a paucity of guidelines regarding their management in the acute setting. The evaluation of seizures is variable and can be costly and lengthy, so standardization of evaluation would benefit both the patients as well as the medical system. DESIGN/METHODS: We retrospectively analyzed the charts of 300 representative patients seen in our ED between 2010-2013 and examined the following variables: new or prior diagnosis of seizure, type of seizure if known, patient age, patient gender, mode of arrival, description of pertinent seizure details in ED note, time spent in the ED, labs collected, imaging obtained, ancillary testing, medications or interventions administered, admission to inpatient service, recommended follow-up, frequency of neurology consults, neurologist’s diagnosis, and associated factors such as psychiatric illness, drug use, medication noncompliance, and lack of access. RESULTS: A majority of patients had a prior diagnosis of seizure, with most patients getting labs and/or imaging. EEG was underutilized. More than half had medications adjusted in the ED. Substance use and medication noncompliance were common triggers. Consulting neurology significantly increases time in ED. CONCLUSIONS: Patients with seizures commonly present to the ED and their evaluation is variable and arguably arbitrary. We propose an emergency department seizure care pathway to avoid unnecessary tests, decrease expense, and reduce ED utilization while improving patient satisfaction and quality of care. Study Supported by: Disclosure: Dr. Peters has nothing to disclose. Dr. Onofrei has nothing to disclose. Dr. Barkan has nothing to disclose.