Pathology testing in non‐trauma patients presenting to the emergency department with recurrent seizures

Abstract

ObjectiveExcessive pathology testing is associated with ED congestion, increased healthcare costs and adverse patient health outcomes. This study aimed to determine the frequency, yield and influence of pathology tests among patients presenting to the ED with atraumatic recurrent seizures.MethodsThis was a retrospective cohort study conducted at a level 4 adult ED in Australia and included atraumatic patients presenting to ED with recurrent seizures over a 4‐year period (2017–2020). The primary outcome was the frequency of pathology tests. Additionally, the proportion of abnormal pathology test results and the association between pathology tests and change in management were assessed.ResultsOf the 398 eligible presentations, 346 (86.9%, 95% confidence interval [CI] 83.3–89.9%) underwent at least one pathology test. In total 18.3% (n = 517) of pathology tests had an abnormal result which led to 15 changes in ED management among 12 presentations. Patients who had an abnormal pathology test result were more likely to undergo a change in antiepileptic drug management (odds ratio 2.08, 95% CI 1.23–3.65; P = 0.008).ConclusionMost patients presenting to the ED with atraumatic recurrent seizures underwent pathology tests. Abnormalities were frequently detected but were uncommonly associated with change in management. Abnormal pathology test results were associated with changes in antiepileptic drug management although rarely led to acute changes in patient management. This study suggests that pathology tests may be excessively requested in this population.

Seizure Analysis Presented to Emergency Department in Saudi Arabia: New VS Chronic Cases

“…Furthermore, 57.7% (56/97) of patients exhibited abnormal antiepileptic drug (AED) levels, a figure exceeding our study's finding of 47.4%, which could be attributed to the study's focus solely on nontraumatic patients. ( 17 ) Consistent with our findings, investigations into known seizure cases echoed outcomes observed in new onset seizure patients. In either scenario, laboratory testing demonstrated limited diagnostic value, primarily serving to elucidate the underlying etiology of the seizures.…”

“…In either scenario, laboratory testing demonstrated limited diagnostic value, primarily serving to elucidate the underlying etiology of the seizures. ( 17 - 19 ) Additionally, our study failed to find an association with creatine kinase and seizures, which have long been established to have a positive correlation in most instances. ( 19 ) This elevation usually occurs due to strenuous muscle contraction that occurs during seizures.…”