3 Non-epileptic seizures in the emergency department: an audit

Abstract

Objective Non-epileptic seizures (NES) commonly present via the emergency department (ED) and may lead to inappropriate and/or costly treatment. This baseline audit aimed to determine the prevalence of NES presenting to the ED of the Royal Sussex County Hospital, a tertiary centre in Brighton, over the course of one year. It also recorded whether these patients were being flagged on the electronic patient records (EPR) system and what management they received. Method A list of all patients presenting to the ED over a 1 year period with any of the keywords ‘seizure’ ‘fit’ ‘epilepsy’ in the presenting complaint was generated using the EPR system. We classified the seizures as epilepsy, NES, mixed, secondary, or awaiting diagnosis by: searching electronic discharge summaries and electronic psychiatry patient records, cross-checking with neurology and neuropsychiatry services, and notes review. Once the NES patients were identified, we quantified the number who had been flagged on the EPR and recorded the management they received during their hospital admission. Results Out of 1242 presentations of seizures to the ED over the course of a year, 101 were NES (8.1%). This accounted for 42 of 908 patients who presented with seizures (4.6%). 13 of these patients were flagged on the EPR system. 43% of this group of NES patients attended the ED more than once over the course of the year. There were 31 admissions of NES patients over the year (45.2% with a known diagnosis of NES at admission, 54.8% without a firm diagnosis), ranging from 1 to 33 days in length. Those with a firm diagnosis of NES at the time of admission had an average length of stay of 2 days and had no emergency calls put out; those without a firm diagnosis had an average length of stay of 6 days and 3% had between 1 and 4 medical emergency calls during their admission. Conclusions Non-epileptic seizures make up an important proportion of seizure presentations to the ED, and these patients commonly re-present. It is important that such patients are flagged with a clear management plan in place if the diagnosis of NES is established, and if needed neurological and neuropsychiatric assessment is not delayed in order to minimise harmful interventions and length of stay.