An Analysis of Status Epilepticus Treatment in the Emergency Department in Detroit: A Retrospective Review
Jason Liu1, Tabassum Chowdhury1, Melissa Ly1, Manik Tetarbe2, Shatha Wahbi1, Maysaa Basha3, Deepti Zutshi1
1Wayne State University School of Medicine, 2Detroit Medical Center, 3Wayne State University, Detroit Medical Center
Objective:
To analyze the management of status epilepticus (SE) patients in an urban emergency department (ED).
Background:
SE is defined as continuous seizure activity lasting more than 5 minutes or recurrent seizures without interval return to baseline. It is associated with high morbidity and mortality.
Design/Methods:
A retrospective study was conducted on 996 seizure visits in the Detroit Medical Center (DMC) ED between June 1, 2018 and December 31, 2018. Data on patient demographics, seizure history, diagnostic tests, and subsequent ED visits was collected. We compared between the SE group and a non-SE seizure control (SC) group.
Results:
We identified 93 SE visits and 903 SC visits. The SE group was administered benzodiazepines, anti-seizure medications (ASMs), and anesthetics significantly more often (p <0.0001). The SE group was significantly more likely to be intubated, have acute imaging performed, and be admitted to the ICU (p <0.0001). Despite the increase in acute imaging, there was no difference in imaging showing acute abnormalities (p =0.83). SE visits who received benzodiazepines were admitted to ICU more often (p =0.0004) and were more likely to stay greater than one week (p =0.02). Patient visits with poor ASM adherence were more likely to stay greater than one week than those with ASM adherence (p =0.02).
New-onset SE (nSE) patients were significantly more likely to be discharged with ASMs (p =0.01) than new-onset seizures without status (noSC). NSE patients were significantly less likely to be discharged with ASMs than SE patients with a history of seizures (phSE) (p =0.004). NSE had fewer return ED visits for seizures compared to phSE (p =0.00005).
Conclusions:
For patients with SE, having a history of seizures and medication non-adherence significantly affected management and outcomes. These may be future targets to focus on in studies reviewing risk reduction for patients presenting with recurrent SE.