Abstracts

Rationale: Patients with seizure disorder are commonly admitted in the emergency department (ED) but the proportion of known epileptic patients (KEP) as well as their management remains unclear. This study was performed to define the frequency of KEP, their characteristics and how they use emergency medical system (EMS) and ED resources.Methods: We conducted a prospective study at an academic ED involving consecutive patients admitted for seizures, categorized as KEP and unknown epileptic patient from the 7th November 2011 until the 7th November 2012. We excluded patients who were admitted directly in intensive care unit. Pre and intra-hospital data were collected in ED with the help of a pre-established questionnaire. We detailed clinical data, characteristics of epilepsy, modality of follow-up and management in ED. Retrospective chart review was used to gather intra-hospital data upstream to the ED. Results: Among the 57298 admissions in ED, 955 (1.7%) were linked to seizure motive. Of the 955 participants recruited, 516 (57.4%) were for KEP (59% men, mean age 43 years [SD 20.3 years]). The rate of admission was 1.26 patient per year. Thirty eight (7.4%) patients received none antiepileptic drugs (AEDs), 260 (54.4%) single one and 216 (42%) > 2. A third of the patients were followed by a specialist of epilepsy. Concerning the pre-hospital management, 388 (75%) patients utilized EMS call centre and 369 (71.5%) came from their place of residence, 35 (7%) received therapeutics before the admission. At the ED, 64 (12.4%) admissions for seizure was associated with traumatism or head injury, 216 (42%) patients were admitted for serious or complicated seizures included 23 (4.5%) for status epilepticus. Fifty five (55) patients were followed for idiopathic generalized epilepsy (10.7%), 25 for hippocampal sclerosis or malformation of cortical development (4.8%), 91 (17.6%) for cryptogenic focal epilepsy, 102 (19.7%) for epilepsy of vascular origin, 58 (11.2%) for brain tumor and 38 (7.4%) for post-traumatic epilepsy. Concerning the management in the ED, 105 (23%) patients were assessed by brain imaging (64 by computed tomography and 41 by magnetic resonance imaging) and 61(12%) by EEG. Three hundred ninety-four (76.4%) patients received neurologic consultation. The ED length of stay was 5h24 [SD 4h20 hours]. At the end of the ED management, 40 % of patients were admitted for a simple seizure not requiring specific investigations whereas 231 (45%) were hospitalized. The median of length of hospital stays was 4 days [SD 11.1 days] with a rate of mortality of 1.36%.Conclusions: Patient admitted for seizure in ED concerned mainly patients with established epilepsy, and their admission was associated to a high amount of resources. However, our results suggest that some ED visits could be avoid in a large number of patients. Further studies should be performed in order to optimize the seizure care pathway in KEP.