Abstracts

Rationale: Status epilepticus (SE) is defined as a time-sensitive neurologic emergency involving seizure activity lasting 30 minutes or more and is associated with a markedly high morbidity and mortality rate. Lack of standardized identification of those who are at increased risk for SE, as well as an underappreciated prevalence, are thought to contribute to such rates. Currently there exists a rudimentary and inconsistently used tool by which high-risk patients can be identified. This lapse in diagnosis results in failure to provide relevant patients with the tools and resources to adequately recognize and treat seizure emergencies outside of the hospital. This also results in exorbitant costs attributed to emergency department visits and hospital admissions for SE and other seizure-related emergencies. This pilot project investigates a reliable and feasible way in which epilepsy patients who are at increased risk for experiencing SE are identified and therefore provided with a sufficient emergency rescue medication regimen in order to decrease risk of mortality and morbidity as a result of SE.

Methods: Epilepsy providers were surveyed for what they consider to be common risk factors for SE. Patient charts were reviewed for documentation of risk factors for SE. Each was assessed for whether or not the patient would have been considered high-risk per the predetermined criteria outlined previously in the provider focus group. Using data collected from both the focus group discussion and the archival chart review, a risk assessment tool was drafted for provider use in routine clinical documentation.

Results: Three factors were determined to comprise what will be referred to as criteria for high-risk for future utilization of the tool in the medical chart: the patient is considered medically refractory, has a history of an implanted antiseizure device, and is prescribed 3 or greater daily antiepileptic drugs. Preliminary data was analyzed and signaled the need for intervention. Qualitative feedback from the providers who had used this first-draft scorecard in their patients’ charts during the first intervention phase revealed relative ease of use.

Conclusions: There is considerable room for improvement in the process by which epilepsy patients are identified as being predisposed to experiencing a fatal emergency seizure episode. The results of this research project provide evidence that a standardized approach to identification and documentation would be both practical for clinician use and advantageous in reducing the morbidity and mortality rates among epilepsy patients.

Funding: Please list any funding that was received in support of this abstract.: N/A.