Emergency department neuroimaging for epileptic seizures

Epilepsia
Martin SalinskyJoseph Nguyen

Abstract

To determine the frequency and yield of neuroimaging in patients with known seizure disorders presenting to the emergency department (ED) with recurrent (nonindex) seizures. We reviewed 822 consecutive ED visits for nonindex seizures at the Oregon Health & Science University and the VA Portland Health Care System. For each visit, we abstracted details of the clinical presentation, whether neuroimaging was obtained, the results of neuroimaging, and the results of previous neuroimaging studies, when available. We determined whether ED neuroimaging led to an acute change in patient management (yield). Clinical factors associated with obtaining ED neuroimaging, and with the yield of neuroimaging, were evaluated by multivariate logistic regression. A majority (78%) of ED seizure visits were for nonindex seizures. Neuroimaging was obtained in 381 of 822 nonindex seizure visits (46%). Of these, 11 imaging studies (3%) led to an acute change in patient management, 8 (2%) after excluding false-positive scans. Acute head trauma, prolonged alteration of consciousness, and a focal neurologic examination at presentation were associated with an increased yield of ED neuroimaging. Absent any of these 3 clinical factors the true positive yield...Continue Reading

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Citations

Aug 3, 2018·British Journal of Hospital Medicine·Ella GrilzRebecca Pearson
Mar 28, 2019·The Neurohospitalist·Kathryn A KvamJohn P Betjemann
Mar 20, 2020·Clinical Medicine : Journal of the Royal College of Physicians of London·James W MitchellAnthony G Marson
Dec 28, 2019·Journal of Family Medicine and Primary Care·Abhijit G HonavarKundavaram P P Abhilash
Sep 11, 2020·Epilepsy & Behavior : E&B·Layton LamsamKathryn A Kvam
Aug 23, 2020·Journal of the American College of Radiology : JACR·Kristie YangGelareh Sadigh
Jan 5, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Derek L IsenbergNina T Gentile
Jun 12, 2021·Seizure : the Journal of the British Epilepsy Association·Elisabeth M DoranColin P Doherty
Sep 18, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Michael BurgessBiswadev Mitra
Oct 8, 2021·Seminars in Neurology·Myriam AbdennadherMilena K Pavlova
Nov 3, 2021·Journal of Neurology·Lili C S ReineckeMartin Holtkamp

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