Abstracts

Rationale: The emergency department is a common setting for epilepsy and seizure care, especially for socially and economically disadvantaged patients, as well as minorities. Data suggest that seizure patients from racial/ethnic minorities are more likely to be discharged from the emergency department (ED) following a seizure, and less likely to have neuroimaging. Methods: We reviewed the charts of patients seen in our tertiary care ED for seizure or epilepsy from 1/1-6/30/2008 (ICD9 codes 345, 780.3, and 333.2). We recorded demographics, ED evaluation, and number of prior ED visits in the past year. Two epilepsy specialists independently reviewed each chart, and excluded patients deemed not to have had seizures. We test the hypothesis that Whites are more likely to be have neuroimaging and be admitted, using odds ratios (OR) and their 95% confidence intervals (95%CI). Results: We identified 291 visits by 262 unique patients. Sixteen patients made 45 of the visits. Of the 291 ED visits, 56% ended in discharge. Blacks and Hispanics were more likely to have visited the ED multiple times in the past year (OR 2.5; 95% CI 1.26-4.9) and more likely to be using only one antiepileptic drug (OR 0.37; 95% CI 0.18-0.77). There was no significant difference in likelihood of imaging by race/ethnicity. Conclusions: Whites seen in the ED for seizure were less likely to have made multiple ED visits in the past year, and more likely to be on polytherapy with anticonvulsants, relative to minorities. We did not observe any difference in neuroimaging by race/ethnicity. Reasons for these observed disparities in ED epilepsy care need to be investigated further.