Abstracts

Rationale: Emergency department (ED) utilization is higher in Canada than the U.S. and continues to rise, despite the availability of alternative and fully insured health care. Furthermore, studies show that one third of ED visits are non-urgent. The unpredictability and stress associated with seizures leads to high ED use by patients with seizures relative to other patient groups. This study hypothesizes a substantial proportion of these patients could be classified as “potentially deferrable,” defined as those cases that would have been more appropriately cared for in a non-ED setting. The objective of this study is to describe and determine the total number of patients who presented to an ED in the City of London, Ontario with a seizure event in the year 2005, and to estimate the proportion of these patients who may be classified as “potentially deferrable.” Methods: A retrospective chart review of all patients identified with a seizure event who reported to London Health Sciences Centre, including University Hospital and Victoria Hospital, and St. Josephs Urgent Health Care Centre in the year 2005 was conducted. The Medical Records Department identified all patients whose primary reason for a visit was due to epilepsy, status epilepticus, febrile convulsions, or convulsions not elsewhere classified using the ICD-10 coding system. Criteria were developed a priori to classify whether seizure events presenting as a medical emergency were considered such by qualified health professionals or were potentially deferrable. The following seizure events were classified as non-deferrable: first time seizure, status epilepticus, febrile seizure, alcohol or drug withdrawal, increase in seizure frequency or duration, or change in type or post-ictal state, seizure with a secondary injury, patient was admitted or transferred from another hospital. All other seizure presentations were considered as potentially deferrable.Results: A total of 832 patients presented to an ED with a seizure event in 2005, for a total of 1198 visits. Patients’ mean age was 30 years (range 0 - 95), 65% were female, and 35% were under 18 years of age. The reason for visit (ICD-10 code) in 11.8% of patients was epilepsy, 6.0% status epilepticus, 10.3% febrile seizures, and 71.2% unspecified convulsions. Of the patients, 28% presented with a first time seizure, 9% reported an increase in seizure frequency or duration, or change in type or post-ictal state, while 10% reported a secondary injury. A total of 15% of patients were admitted to hospital. Using the criteria, 426 (36%) visits were classified as potentially deferrable. For visits among patients under 18 years of age, 21% were classified as potentially deferrable.Conclusions: A substantial proportion of patient visits to EDs in London, Ontario for seizure events are potentially deferrable. This presents an opportunity for educational intervention to increase efficiency of ED use by patients and families dealing with seizures, and to decrease health care costs associated with potentially deferrable visits.