WHEN IS AMBULANCE TRANSPORT NECESSARY FOR PATIENTS WITH A SINGLE OUT-OF-HOSPITAL SEIZURE?
Abstract number :
3.117
Submission category :
Year :
2002
Submission ID :
3540
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Brian K. Alldredge, Megan D. Corry, Lisa Z. Li, Faith Allen, Nelda O[ssquote]Neil, Daniel H. Lowenstein. Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA; Department of Neurology, University of California, San Fr
RATIONALE: In the San Francisco Emergency Medical Services (SF-EMS) system, an ambulance is often dispatched for patients who have experienced a single out-of-hospital seizure. Most of these patients are transported to an emergency department for further evaluation. There is a need to develop evidence-based criteria for paramedic triage and transport of patients with a single out-of-hospital seizure.
METHODS: We retrospectively reviewed the SF-EMS paramedic patient care records and emergency department records of 215 patients who experienced a single, out-of-hospital seizure and were transported to an emergency department. Cases were evaluated for demographic information, clinical history, and management in the pre-hospital and in-hospital environments.
RESULTS: At the time of paramedic evaluation of these 215 patients, 27 patients (13%) had evidence of head trauma, 115 patients (54%) were confused (GCS[lte]14), and in 49 patients (23%) there was no indication that these patients had ever experienced a prior seizure in their lifetime. A total of 142 patients (66%) met at least one of the above criteria. The remaining 73 patients were atraumatic, known to have a history of prior seizures, and were awake and alert at the time of ambulance transport. Of these latter patients, 68 patients (93%) were discharged directly to home from the emergency department. A complicating medical condition (other than seizure) was present in four of the five patients admitted to the hospital. Only four patients experienced a recurrent seizure in the emergency department and all of these patients were discharged directly to home.
CONCLUSIONS: Patients with a single, out-of-hospital seizure are commonly encountered by paramedics. Many of these patients are atraumatic, known to have a prior history of seizures, and are fully conscious at the time of paramedic evaluation. These patients are unlikely to have recurrent seizures in the emergency department or to have a complicating medical condition that is unknown to the paramedics. Emergency medical services systems should consider these findings in the development of triage and transport criteria for patients with out-of-hospital seizures.
[Supported by: A grant from the National Institutes of Health (RO1 31403)]