Abstracts

Rationale: This study sought to evaluate the population of children with a chief complaint of seizures, presenting to the emergency room (ER) at Children’s National Medical Center (CNMC), a major urban pediatric center, to determine the demographics and primary reasons for ER utilization. It was hypothesized that at least some of these ER visits may have been avoidable through preventative measures including education and proper seizure management. The goal was to gain a better understanding of the children and caregivers and mitigate unnecessary ER visits by children with seizure disorders through appropriate interventions. Methods: Medical records of children admitted to the ER with the diagnosis of epilepsy or a chief complaint of seizures were randomly selected and reviewed from May 2006 through January 2007. A total of 223 ER visits were selected for initial reviews. Of these visits, 171 were determined to be appropriate and justified in their presentation to the ER. Extensive chart reviews were then performed on the remaining 52 patients. Results: In the group of 52 children, (25 girls and 27 boys), the average age was 8.6 years with a range from 33 months to 19 years. The average length of diagnosis was 3 years with a range of one month to 13 years. Nine children had seizures in school or a group home where transportation to the ER is standard protocol. Of the remaining 43, 18 had either newly diagnosed seizures, seizures that looked different from the norm or the child’s lips turned blue, or the seizure lasted for more than 5 minutes, all of which are circumstances where ER visits were advised. The remaining 25 presented with breakthrough seizures due to unknown origin (n=10), secondary to fever or illness (n=3), a recent change or needed change in medications (n=3), pseudoseizures (n=1), a new seizure after a year of control (n=2), and a lack of medications or non-compliancy with medications (n=6). In this group of 25, Diastat was prescribed to a total of eight children, and used only by three parents prior to the ER visit. Conclusions: Of 223 children seen at CNMC, during an 8-month period 25 (11.2%) of the ER visits were potentially avoidable. The rate of avoidable ER visits by children with epilepsy was less than, expected. ER visits for children with epilepsy can be a difficult issue to address, since the reasons for the ER visits are quite variable. Also, it is likely that parents differ widely in terms of their family dynamics, resources, and confidence in their ability to manage seizures at home. ER visits provide potential opportunities for education and intervention. Possible interventions for mitigating unnecessary ER visits could be education about seizure triggers including fever, changes in medications, and missed medications, compliance and timely refills of medication, and increasing the use of Diastat. The ten parents who elected to visit the ER due to breakthrough seizures of unknown origin would need to be interviewed in order to gain a better understanding of how these visits might have been avoided.