Abstracts

Rationale: A “code blue” is called when observers believe that a patient is undergoing a life-threatening event. At Mayo Clinic Arizona (MCA) each code blue event consumes considerable resources with 12 members of the code team taken away from their usual clinical duties for a minimum of 20 minutes. It was unknown how often seizures account for code blue calls. The epilepsy team has anecdotally observed that code blue events occurring in the hospital lobby frequently present with a seizure-like appearance. The purpose of this study is to determine the frequency and characteristics of code blue calls for patients with presumed seizures versus its mimickers. Methods: All code blue events at MCA from January 2001 to December 2008 were analyzed using the MCA Code Blue Report Log. Every code blue call for seizure or seizure-like events was identified. For each of the identified events, the electronic medical record was reviewed for the location of the event, final diagnosis, and presence of a known seizure disorder. Results: A total of 948 code blues were called over the eight year period, 225 (24%) of which were a true loss of spontaneous circulation and 478 (50%) constituted other medical emergencies. Out of the 478 events, 50 (10.5%) were identified as seizure/seizure-like spells. 28 (56%) occurred in hospital inpatients, while the other 22 (44%) events occurred on the hospital premises to either outpatients, visitors, or employees. The hospital lobby was a common location for seizure code blue events, 8 of 22 (36.4%) occurred there while either awaiting admission to the epilepsy monitoring unit (EMU) (n=5) or waiting for an outpatient neurology appointment (n=3). Of the 8 lobby events, 5 had a known diagnosis of epilepsy and 2 were diagnosed as psychogenic nonepileptic seizures (PNES). Of the 50 seizure-like events 7 (14%) were non-epileptic. Of these 2 occurred as inpatients (laryngospasm and convulsive syncope), whereas 5 occurred as outpatients and all had a diagnosis of PNES. Code blues from a first epileptic seizure were likely to occur in inpatients as compared to outpatients. 21 (75%) of the 28 inpatients presented with their first seizure triggering a code blue call, whereas only 1 of the 22 (4.5%) outpatient code blue events were first time seizures. Conclusions: This study provides insights regarding how code blues are called on hospitalized versus non-hospitalized patients with seizure-like events. The majority of seizures were self limited and none required cardiac resuscitation. Code blue events in the outpatient lobby often occurred in patients awaiting evaluation by neurology. If an outpatient has a code blue event that is non-epileptic it likely represents PNES. Furthermore, first time seizures generating a code blue response are more likely to be inpatients than outpatients, visitors, or employees. This review demonstrates the comfort of inpatient and outpatient personnel response to seizure-like events. Although code blue events due to seizure-like activity are relatively rare, this data demonstrates that there is an opportunity for further education regarding response to seizures and seizure-like events.