First Time Non-Provoked Seizure Presentation to the ED Decision Analysis
Lauren A. Tanaka1* and Loren G. Yamamoto, MD, MPH, MBA2
1 Kapi`olani Medical Center for Women & Children, Honolulu, HI, USA.
2 University of Hawai`i John A. Burns School of Medicine, Honolulu, HI, USA.
*Corresponding Author: Lauren A. Tanaka, Kapi`olani Medical Center for Women & Children, Honolulu, HI, USA.
DOI: https://doi.org/10.58624/SVOAPD.2024.03.077
Received: July 23, 2024 Published: August 13, 2024
Abstract
Background: Majority of pediatric patients who present to the Emergency Department (ED) with a first time unprovoked seizure are not fully worked up during their ED stay and are instead hospitalized for further evaluation. Obtaining a full work up in the ED has not been widely studied but could prove to ensure more cost-effective treatments, decrease resource utilization, and reduce physician work.
Methods: A retrospective chart review was performed for all patients under 18 years old presenting to the ED with first time unprovoked seizures from January 2014 through May 2022. 194 patients were included in the study and an evaluation strategy score was calculated for the patients who received a full evaluation (EEG, brain imaging, decision to start anticonvulsants) in hospitalized patients, ED patients (all elements completed in ED), and outpatient (all elements completed in ED and outpatient setting) patients. This score was a proxy measure for physician work and hospital resources consumed to manage the patient.
Results: Patients who received a full workup in the ED had the lowest evaluation work score (5.3) followed by those who received an outpatient workup (5.4) and inpatient workup (10.6) (p<0.001). The outpatient workup took the longest to receive their necessary EEG (836 hours) and brain imaging (1401 hours). The ED workup strategy took the least amount of time to receive their EEG (3.6 hours) and brain imaging (3.1 hours) which yielded a faster anticonvulsant decision.
Conclusion: Our decision analysis showed that the ED workup strategy had the lowest resource utilization score and was the fastest to complete the necessary EEG, brain imaging, and anticonvulsant medication decisions for patients presenting to the ED with a first time unprovoked seizure. The workup for a first time unprovoked seizure can be tedious, thus physicians should consider fully working up these patients in the ED.
Keywords: Seizure, Convulsion, Disposition, Hospitalization, EEG, Neuroimaging, Brain Imaging, MRI Scanning, CT Scanning, Anticonvulsants, Antiepileptic Drugs, Decision Analysis, Resource Utilization
Citation: Tanaka LA, Yamamoto LG. First Time Non-Provoked Seizure Presentation to the ED Decision Analysis. SVOA Paediatrics 2024, 3:4, 122-131. doi:10.58624/SVOAPD.2024.03.077