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Neurohospitalist. 2019 Apr;9(2):71-78. doi: 10.1177/1941874418808676. Epub 2018 Nov 18.

Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure.

Author information

1
Department of Neurology, Stanford University, Stanford, CA, USA.
2
Department of Neurology, University of California, San Francisco, CA, USA.
3
Department of Emergency Medicine, University of California, San Francisco, CA, USA.

Abstract

Background:

Studies of emergent neuroimaging in the management of patients presenting with a breakthrough seizure are lacking. We sought to determine how often emergent computed tomography (CT) scans are obtained in patients with known epilepsy presenting with a seizure and how often acute abnormalities are found.

Methods:

This multicenter retrospective cohort study was performed in the emergency department at 2 academic medical centers. The primary outcomes were percentage of visits where a CT scan was obtained, whether CT findings represented acute abnormalities, and whether these findings changed acute management.

Results:

Of the 396 visits included, CT scans were obtained in 39%, and 8% of these scans demonstrated acute abnormalities. Patients who were older, had status epilepticus, a brain tumor, head trauma, or an abnormal examination were all significantly more likely to undergo acute neuroimaging (P < .05). In the multivariable model, only history of brain tumor (odds ratio [OR] 5.88, 95% confidence interval [CI], 1.33-26.1) and head trauma as a result of seizure (OR 3.92, 95% CI, 1.01-15.2) reached statistical significance in predicting an acutely abnormal scan. The likelihood of an acute imaging abnormality in visits for patients without a history of brain tumor or head trauma as a result of the seizure was 2.7% (2 visits). Both of these patients had abnormal neurological examinations.

Conclusion:

Obtaining an emergent CT scan for patients with epilepsy presenting with a seizure may be avoidable in most cases, but might be indicated for patients with a history of brain tumor or head trauma as a result of seizure.

KEYWORDS:

CT; computed tomography; emergency; epilepsy; seizure

PMID:
30915184
PMCID:
PMC6429671
[Available on 2020-04-01]
DOI:
10.1177/1941874418808676

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: VCD receives compensation as Editor-in-Chief of The Neurohospitalist. SAJ receives personal compensation in his role as Editor-in-Chief of JAMA Neurology and as Associate Editor for Continuum Audio. JPB receives personal compensation for serving as web editor of JAMA Neurology. KAK reports no conflict of interest.

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