Abstracts

Rationale: Emergency department (ED) visits constitute a significant part of the health care utilization and economic burden of epilepsy. There are relatively few descriptive studies of adult and pediatric patients with epilepsy in the ED that include a significant Native American and Hispanic population. We hypothesized that by studying this population, we could identify potential interventions to improve care and healthcare utilization. Methods: Observational retrospective analysis of adult and pediatric patients, who presented to emergency department at University of New Mexico Hospital with seizures between August, 2012 and April, 2013. Admissions for elective epilepsy monitoring or characterization of spells were excluded.Results: We identified 175 consecutive patients for inclusion who presented to UNMH ED between August, 2012 and April 2013 with a diagnosis of seizures. There were 126 adults and 49 pediatric patients. These patients accounted for 253 ED visits, and 70% (n=178) of the visits were by adults, and 30% (n=75) were by pediatric patients. The final etiology of adults referred for seizures was epilepsy in 28% (n=49) of visits, non- epileptic episodes in 4% (n=7) and unknown in 45% (n=80). The final etiology of pediatric patients referred for seizures was epilepsy in 61% (n=46), non- epileptic episodes in 3% (n=2) and unknown in 28% (n=21). There were 77% (n=137) of adult patients and 68% (n=51) of pediatric patients prescribed antiepileptic drugs (AEDs) prior to ED admission. AED levels were drawn in 68% (n=93) and 61% (n=31) respectively. Low drug levels were present in 69% (n=64) of adults and 45% (n=14) of children. Urine toxicology was performed in 37% (n=67) and alcohol levels in 18% (n=32) of adult patients. Positive results were obtained in 46% and 31%, respectively. Urine toxicology was performed in 9% (n=7) and an alcohol level in 1 of the pediatric patients. Positive urine toxicology occurred in 43% (n=3). More than one ED visit in the 10 months prior to entering the study occurred in 15% of the adult and 17% of the pediatric patients. In this group, 88% of patients were on AEDs; and among those with AED levels drawn, 75% of all on AEDs were found to have low levels. A diagnosis of epilepsy was given to 45% and the etiology remained unknown in 33%. Conclusions: We found that poor compliance was a common risk factor for both adult and pediatric patient referrals to the ED (see table below). Two thirds of those with AED levels drawn were subtherapeutic. Additional risk factors for seizure control included drug or alcohol use (positive in over 40% of those tested). Additional risk factors included the lack of a complete diagnostic evaluation (over 1/3 of our subjects did not have a well-established diagnosis) and lack of access to outside medical records. We conclude that epilepsy and utilization of healthcare resources in the ED could be improved, by developing both ED guidelines that include routine drug, alcohol and AED screening, and follow-up care programs to address the special needs of these patients.