Abstracts

Rationale: In the United States, there is an estimated 3.4 million people with epilepsy resulting in healthcare costs approximating 9.6 billion dollars annually. Patients with epilepsy (PWE) visit the emergency department (ED) 0.9 to 1.2 times per year costing an estimated $1.2 billion annually. Neuroimaging and electroencephalography (EEG) can be used in the acute setting to recognize subclinical seizures, diagnose seizure type, and to establish the risk for recurrent seizures. The purpose of this study was to analyze the utilization of neuroimaging and EEGs performed in the ED in patients presenting with acute seizures. Our secondary objective was to compare the difference in utilization of imaging, EEG, treatment, and seizure recurrence rates between patients presenting with alcohol and non-alcohol related seizures._x000D_
Methods: A retrospective study was conducted on all patients age 18 years and older who visited the ED at the Detroit Medical Center (DMC) including academic and non-academic settings. We obtained data from June 1, 2018, through December 31, 2018, and reviewed a selected cohort of patients. We collected demographic data, diagnostic imaging and EEG results, anti-seizure medication and epilepsy history data, admission, discharge and repeat ED visit data for seizures. We excluded patients with a history of seizures who came to the ED for medication refills.

Results: We collected data on 203 visits in 146 unique patients who presented to the ED with seizures. Of the 203 visits, 100 visits (49%) had at least one CT-head scan performed, of which only 5 (2.5%) showed an acute finding (ICH, stroke, tumor). Of the total number of visits, 35 (15.8%) had EEGs performed, of which 26 (71.9%) had abnormal findings resulting in a change in management. Regardless of the specific findings on EEG, all patients (100%) with an abnormal EEG were admitted to the hospital. Out of the 203 visits, 31 (15.3%) had documented recent alcohol use, while 172 (84.7%) did not. Comparing utilization between academic vs. non-academic hospitals, there was no significant difference between the number of CT-head scans performed in academic vs. non-academic neurological centers. However, there was a slightly higher rate of EEG utilization in academic (87%) vs. non-academic (81%) hospital settings.

Conclusions: CT scans performed on acute seizure patients with new or chronic seizures shows a low yield of neurological findings. There was no significant difference between the number of neurological scans performed in academic neurological centers vs. non-academic neurological centers, however there was a slightly higher rate of EEG utilization in academic hospitals. Patients who had an EEG are more likely to be admitted and/or have a change in their management. There was no significant difference between ED visits for alcohol and non-alcohol related seizures regarding utilization of imaging, EEG, AED prescription, or return to the ED. Further studies with a larger cohort sample and multivariate regression analyses can be used to determine which patients would benefit from neuro-imaging and EEG after experiencing seizures in the ED to reduce healthcare costs and systemic burdens.

Funding: None