Cross-sectional study of the hospital management of adult patients with a suspected seizure (EPIC2)

Objective

To determine the clinical characteristics, management and outcomes of patients taken to hospital by emergency ambulance after a suspected seizure.

Design

Quantitative cross-sectional retrospective study of a consecutive series of patients.

Setting

An acute hospital trust in a large city in England.

Participants

In 2012/13 the regions ambulance service managed 605,481 emergency incidents, 74,141/605,481 originated from Sheffield (a large city in the region), 2,121/74,141 (2.9%) were suspected seizures and 178/2,121 occurred in May 2012. We undertook detailed analysis of the medical records of the 91/178 patients who were transported to the city’s acute hospital. After undertaking a retrospective review of the medical records the best available aetiological explanation for the seizures was determined.

Results

The best available aetiological explanation for 74.7% (68/91) of the incidents was an epileptic seizure, 11.0% (10/91) were psychogenic non-epileptic seizures (PNES) and 9.9% (9/91) were cardiogenic events. The epileptic seizures fall into the following four categories: first epileptic seizure (13.2%, 12/91), epileptic seizure with a historical diagnosis of epilepsy (30.8%, 28/91), recurrent epileptic seizures without a historical diagnosis of epilepsy (20.9%, 19/91), and acute symptomatic seizures (9.9%, 9/91). Of those with seizures (excluding cardiogenic events), 2.4% (2/82) of patients were seizing on arrival in the Emergency Department (ED), 19.5% (16/82) were post-ictal and 69.5% (57/82) were alert. 63.4% (52/82) were discharged at the end of their ED attendance and 36.5% (19/52) of these had no referral or follow-up.

Conclusions

Most suspected seizures are epileptic seizures but this is a diagnostically heterogeneous group. Only a small minority of patients require emergency medical care but most are transported to hospital. Few patients receive expert review and many are discharged home without referral to a specialist leaving them at risk of further seizures and the associated morbidity, mortality and health services costs of poorly controlled epilepsy.