Marie Girot1, Herve Hubert2, Florence Richard3, Maxime Chochoi4, Dominique Deplanque5, Philippe Derambure6, Patrick Girardie7, Nicolas Pauchet8, Stephanie Leblanc9, Alice Lim10, Eric Wiel11, Pierre Williate12, William Szurhaj13, Xavier Lenne14, Louise Tyvaert15. 1. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: marie.girot@chru-lille.fr. 2. Department of Public Health and EA 2694, University of Lille Nord de France, Lille, France. Electronic address: herve.hubert@univ-lille2.fr. 3. INSERM UMR 744, University of Lille Nord de France, Lille, France. Electronic address: florence.richard@chru-lille.fr. 4. Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: maxime.chochoi@chru-lille.fr. 5. Department of Pharmacology, EA 1046 and CIC 1403 INSERM, University of Lille Nord de France, Lille, France. Electronic address: dominique.deplanque@chru-lille.fr. 6. Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: philippe.derambure@chru-lille.fr. 7. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: patrick.girardie@chru-lille.fr. 8. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: nicolas.pauchet@chru-lille.fr. 9. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: stephani.leblanc@gmail.com. 10. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: alice.lim@chru-lille.fr. 11. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: eric.wiel@chru-lille.fr. 12. Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: pierre.williate@chru-lille.fr. 13. Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: william.szurhaj@chru-lille.fr. 14. Department of Medical Information, University of Lille Nord de France, Lille, France. Electronic address: xavier.lenne@chru-lille.fr. 15. Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: l.tyvaert@chu-nancy.fr.
Abstract
BACKGROUND AND PURPOSE: Seizure is a frequent reason of admission in emergency department (ED) but little is known about the proportion and the characteristics of known epileptic patients (KEPs) who used emergency services. METHODS: Over a 12-month period, we prospectively recruited adults admitted for seizure to a tertiary hospital ED. For KEPs, clinical epilepsy features and characteristics of the admission were collected. RESULTS: Of the 60,578 ED admissions, 990 were related to seizure; 580 of these admissions concerned 448 different KEPs (257 males; median age: 44); 339 were residents in the health district. Epilepsy was structural/metabolic in 268 (59.8%) patients, genetic in 44 (9.8%) and unknown/undetermined in 136 (30.3%); 218 (48.7%) patients were under a single antiepileptic drug and 135 (30.1%) were followed by an epileptologist. Of the 580 KEP admissions, 440 (75.8%) concerned patients who had called the emergency medical assistance number, 252 (43.4%) with a discharge diagnosis of usual seizure and 43 (7.4%) of a status epilepticus. Half the KEPs were discharged without hospitalization. We estimated that 9.0% of KEPs residing in the district had used the ED during the period. CONCLUSION: Proportion of KEPs using ED is high. Most of the admissions concerned usual seizures suggesting that staff training and educational programmes for patients and for their relatives need to be improved. The organization of the prehospital and of the emergency medical services should also be adjusted to this specific need. Further research should be conducted to optimize the seizure care pathway for KEPs.
BACKGROUND AND PURPOSE:Seizure is a frequent reason of admission in emergency department (ED) but little is known about the proportion and the characteristics of known epilepticpatients (KEPs) who used emergency services. METHODS: Over a 12-month period, we prospectively recruited adults admitted for seizure to a tertiary hospital ED. For KEPs, clinical epilepsy features and characteristics of the admission were collected. RESULTS: Of the 60,578 ED admissions, 990 were related to seizure; 580 of these admissions concerned 448 different KEPs (257 males; median age: 44); 339 were residents in the health district. Epilepsy was structural/metabolic in 268 (59.8%) patients, genetic in 44 (9.8%) and unknown/undetermined in 136 (30.3%); 218 (48.7%) patients were under a single antiepileptic drug and 135 (30.1%) were followed by an epileptologist. Of the 580 KEP admissions, 440 (75.8%) concerned patients who had called the emergency medical assistance number, 252 (43.4%) with a discharge diagnosis of usual seizure and 43 (7.4%) of a status epilepticus. Half the KEPs were discharged without hospitalization. We estimated that 9.0% of KEPs residing in the district had used the ED during the period. CONCLUSION: Proportion of KEPs using ED is high. Most of the admissions concerned usual seizures suggesting that staff training and educational programmes for patients and for their relatives need to be improved. The organization of the prehospital and of the emergency medical services should also be adjusted to this specific need. Further research should be conducted to optimize the seizure care pathway for KEPs.
Authors: Adam J Noble; Darlene Snape; Steve Goodacre; Mike Jackson; Frances C Sherratt; Mike Pearson; Anthony Marson Journal: BMJ Open Date: 2016-11-09 Impact factor: 2.692