Seizure visits in US emergency departments: epidemiology and potential disparities in care

Abstract

IntroductionWhile epilepsy is a well-characterized disease, the majority of emergency department (ED) visits for “seizure” involve patients without known epilepsy. The epidemiology of seizure presentations and national patterns of management are unclear. The aim of this investigation was to characterize ED visits for seizure in a large representative US sample and investigate any potential impact of race or ethnicity on management.MethodsSeizure visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1993 to 2003 were analysed. Demographic factors associated with presentation, neuroimaging and hospital admission in the USA were analysed using controlled multivariate logistic regression.ResultsSeizure accounts for 1 million ED visits annually [95% confidence interval (CI): 926,000–1,040,000], or 1% of all ED visits in the USA. Visits were most common among infants, at 8.0 per 1,000 population (95% CI: 6.0–10.0), and children aged 1–5 years (7.4; 95% CI: 6.4–8.4). Seizure was more likely among those with alcohol-related visits [odds ratio (OR): 3.2; 95% CI: 2.7–3.9], males (OR: 1.4; 95% CI: 1.3–1.5) and Blacks (OR: 1.4; 95% CI: 1.3–1.6). Neuroimaging was used less in Blacks than Whites (OR: 0.6; 95% CI: 0.4–0.8) and less in Hispanics than non-Hispanics (OR: 0.6; 95% CI: 0.4–0.9). Neuroimaging was used less among patients with Medicare (OR: 0.4; 95% CI: 0.2–0.6) or Medicaid (OR: 0.5; 95% CI: 0.4–0.7) vs private insurance and less in proprietary hospitals. Hospital admission was less likely for Blacks vs Whites (OR: 0.6; 95% CI: 0.4–0.8).ConclusionSeizures account for 1% of ED visits (1 million annually). Seizure accounts for higher proportions of ED visits among infants and toddlers, males and Blacks. Racial/ethnic disparities in neuroimaging and hospital admission merit further investigation.

Characteristics of Children Admitted to the Emergency Department with Convulsive Epileptic Seizures: A Single-Center Study

“…Previous studies reported that seizures accounted for approximately 1-2% of all pediatric emergency department visits. [7][8][9][10][11] In our study, only 0.28% of all emergency department visits were due to a convulsive epileptic seizure. The very low incidence of seizures among all pediatric emergency department visits may be due to the fact that emergency departments in Turkey have become a common place for both urgent and non-urgent child healthcare provision.…”

A survey of the management of transient loss of consciousness in the emergency department

“…Transient loss of consciousness accounted for 0.95% of all ED attendances, supporting the consistent figure of around 1% in the published literature. [2][3][4][5][6][7] The dominant presentation was neurally-mediated syncope.…”

“…The burden of TLoC presenting as an emergency is significant -in the UK in 2005-6 there were 103,825 completed clinical episodes of syncope and collapse, of which 80% presented as an emergency; there were 50,112 completed clinical episodes of epilepsy in a similar time frame. 1 In contemporary series from Europe and the USA, syncope accounts for between 0.6%-1.4%, and epilepsy 1% 7 of presentations to the emergency department (ED). [2][3][4][5][6] In 2010, the National Institute for Health and Care Excellence (NICE) in the UK published a clinical guideline (CG 109) for the initial assessment and diagnosis of TLoC and onward referral of patients.…”

Emergency Neurological Life Support: Status Epilepticus

“…These visits represent approximately 20 % of ED visits for neurological problems and 1 % of all ED visits [1][2][3]. Approximately, 200,000 US patients per year have prolonged or rapidly recurring convulsions lasting more than 5 min-the defining features of status epilepticus (SE).…”