Objective:

To describe characteristics of adult inpatients evaluated by an Epilepsy Consult Service and assess associations between consultation timing, length of stay (LOS), and discharge disposition.

Background:

Timely epilepsy consultation is critical for diagnosis and inpatient management of seizure-related presentations. Few studies have examined ED presentation patterns, consultation timing, and their impact on hospital outcomes. 

Design/Methods:

A retrospective chart review was conducted of adults (≥18 years) admitted between November 2022 and February 2025 and evaluated by the Epilepsy Consult Service, staffed by five epileptologists, two nurse practitioners, and 24/7 EEG services, including continuous video EEG. Data collected included demographics, ED presentation, consultation indication, time from ED arrival to consult, LOS, and disposition. Early consults were defined as ≤12 hours from ED arrival. Multivariable linear regression analyzed LOS and logistic regression assessed discharge home, adjusted for age, sex, and ED presentation type. Spearman’s correlation evaluated time-to-consult versus LOS. Kaplan-Meier analysis explored time to seizure-related readmission. 

Results:

Among 702 patients (mean age 55.1 ± 17.4 years, 52.6% male), the most common ED presentations were seizure or seizure-like events (61.8%), altered mental state (22.4%), and suspected stroke (6.7%). Median time to consult was 18 hours (IQR 0.5–47); 28% received early consultation (≤12 hours). Early consults were associated with shorter LOS (β = −1.5 days, p = 0.03) and higher odds of discharge home (OR 2.0, 95% CI 1.3–3.1, p = 0.01), after adjusting for age, sex, and ED presentation. LOS correlated positively with time-to-consult (ρ = 0.21, p = 0.01). Kaplan-Meier analysis suggested a longer median time to seizure-related readmission for early consult patients. 

Conclusions:

Early epilepsy consultation (≤12 hours), supported by a dedicated team and 24/7 EEG, is associated with shorter hospitalization, improved discharge outcomes, and delayed readmission. Early involvement of epileptologists represents a scalable strategy to optimize inpatient seizure management.