Abstracts

Indications for Emergent Head CT in People with Breakthrough Seizures at a Level 1 Trauma Center

Abstract number : 3.363
Submission category : 5. Neuro Imaging / 5A. Structural Imaging
Year : 2024
Submission ID : 374
Source : www.aesnet.org
Presentation date : 12/9/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Giwoo Kim, BS – UT Health San Antonio

Shail Vyas, MD – UT Health San Antonio
Charles Szabo, MD – UT Health San Antonio/South Texas Comprehensive Epilepsy Center

Rationale: Computerized tomography (CT) is variably used by emergency departments (ED), yet limited data exists regarding its utility in people with epilepsy (PWE) presenting with breakthrough seizures. We compared demographic and clinical factors between PWE undergoing emergent CT imaging to those who did not.

Methods: This retrospective cohort study reviewed ED admissions between 01/01/2019 and 12/31/2020 at University Hospital (San Antonio, Texas) with a Level 1 trauma center, and identified 137 individual cases of breakthrough seizures in adults ³18 years old. Demographic information, social history, BMI, external signs of head injury (HI), status epilepticus (SE), focal neurologic deficits (FND), Glasgow Coma Scale scores, antiplatelet or anticoagulant use, head CT findings, and time to disposition (TD) were collected. Age at the time of ED admission, BMI, and TD were compared using two-tailed T-Tests; association of demographic and clinical factors differentiating the CT (N=110, 63 M) and non-CT (N=27, 15 M) groups, and between CT subgroups, including normal CT (NlCT, 58%), lesional CT (LCT, 35%) and with an acute traumatic intracranial hemorrhage (ICH, 15%), were evaluated with Fisher Exact Tests.

Results: The CT group was significantly older than the non-CT group (mean 47 vs 36 years, P=0.001), the oldest being the ICH subgroup (mean 55 +/- 16 years). The CT group was more likely to present with HI (P=0.03), FND (P=0.02), and without insurance (P=0.001). The ICH group had a higher rate of HI (P=0.008) and FND (P=0.009) than the remaining CT and non-CT patients combined.

Conclusions: Based upon the high rate of acute traumatic ICH, emergent CT is recommended older PWE presenting with breakthrough seizures especially with evidence of HI and new-onset FNDs. Larger prospective, multicenter studies including trauma centers are needed to validate these - and explore other - potential clinical risk factors for acute ICH.

Funding: None

Neuro Imaging