When Should Emergency Departments Order Imaging Tests for Epileptic Seizures?

JULY 18, 2018 - Emergency department visits for patients with seizures often have them undergoing neuroimaging, typically CT scans. Imaging in adult patients presenting with onset index seizures leads to a change in care for 9 to 17% of patients, however if any changes are made following imaging in the emergency department for seizures among adults with known seizure disorders is uncertain.

An Epilepsia study involving 822 emergency department visits for non-index seizures showed that neuroimaging was performed in 46% of all patients; of these 3% of imaging tests led to an acute change in patient management, 2% after excluding false positive scans. Each visit researchers abstracted details of clinical presentation, whether imaging was obtained and results, as well as results of previous imaging when available to determine if emergency department neuroimaging led to acute change in patient management. Factors associated with obtaining the imaging and yield of imaging were evaluated by multivariate logistic regression.

Increased yield of emergency department neuroimaging was associated with prolonged alteration of consciousness, acute head trauma, and a focal neurological examination at time of presentation. Without any of these three clinical factors true positive yield of neuroimaging was zero, according to the researchers.

Epilepsia is a leading and authoritative source for current clinical research on all aspects of epilepsy, presenting scientific evidence and clinical methodology in: neuroimaging, clinical neurology, molecular biology, neurophysiology, neurochemistry, neuroepidemiology, neurosurgery, and therapeutic trials.

Researchers say findings suggest a more conservative use of emergency department neuroimaging for non-index seizures is supported, based in clinical factors at time of presentation.

Full citation: Martin Salinsky, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-120, Portland, OR 97239. E-mail: [email protected]

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd., reproduced with permission.