Abstracts

Rationale: Many patients with prolonged seizures or status epilepticus are transported to our hospital via helicopter, often from regional emergency departments. In patients with status epilepticus, early treatment intervention has been shown to be critical and the pre-transport, transport, and post-arrival diagnostic and therapeutic management may affect outcome. In addition, we hypothesized that in some cases patients with conditions that mimic prolonged epileptic seizures were undergoing potentially unnecessary treatment and transport.Methods: We performed a retrospective chart review of all adult patients transported by Vanderbilt LifeFlight to our medical center from October, 2006 through April, 2014 with a transport diagnosis of seizures or status epilepticus and identified 104 cases. We assessed the demographic characteristics, discharge diagnosis, diagnostic value of EEG, hospital management, and neurological outcome in this patient population.Results: The most common discharge diagnosis in this population of air medevac transferred patients was new onset seizures seen in 43% of cases (45/104), followed by breakthrough seizures seen in 36% (37/104), psychogenic non-epileptic seizures (PNES) in 17% (18/104), and syncope in 4% (4/104). Thirty cases (29%) met clinical or EEG criteria for status epilepticus. EEG was performed within 24 hours in 62% of cases and was considered diagnostic 31% of the time. Sixty-one percent of patients (62/104) were intubated prior to arrival including 44% (8/18) of patients found to have PNES. At discharge, 76% of patients (79/104) were at neurological baseline, 21% (22/104) had a neurological deficit and 3% (3/104) died in hospital. When comparing patients with status epilepticus to patients with definite or probable PNES, older age (p=0.0001) and male gender (p = 0.0078) were significantly associated with a diagnosis of status epilepticus.Conclusions: The population undergoing air-medevac for seizures is heterogeneous with new onset seizures and breakthrough seizures nearly equally represented. PNES makes up a substantial subset of these patients and represents a population of patients who potentially underwent unnecessary treatment and transfer. EEG was performed within 24 hours in the majority of patients and added critical diagnostic information in nearly one third of cases. Older age and male gender were factors predictive of status epilepticus in this population.