Predictors of early seizure recurrence in patients admitted for seizures in the Emergency Department.

OBJECTIVE

To determine the frequency of early seizure recurrence (ESR) and to evaluate predictors of ESR among patients attending the Emergency Department (ED) for seizure.

METHODS

Prospective observational 12-month study in two Paris metropolitan area EDs including all consecutive adult patients presenting after one or more convulsive seizure episodes. Patients were classified into four groups: alcoholism (A), nonalcoholism (nA), new-onset seizure (NO), and past history of seizures (PS). ESR was defined as a seizure recurrence during the first 24 h after admission.

RESULTS

A total of 1025 patients were enrolled. The groups were as follows: A-NO 176 patients (17.2%); A-PS 263 patients (25.6%); nA-NO 170 patients (16.6%); and nA-PS 416 patients (40.6%). Alcohol-related episodes involved 439 patients (42.8) with 346 NO seizures (33.7%). ESR rates were 16.3 and 18.6% at 6 and 24 h. Alcoholism, diagnostic group, age >or=40 years, glucose >or=5 and >or=8.5 mmol/l, and Glasgow Coma Scale <15 were significantly associated with ESR by univariate analysis. Alcoholism {odds ratio (OR): 1.32 [95% confidence interval (CI): 1.03-1.67]; P=0.02}, plasma glucose [>5 mmol/l, OR: 1.68 (95% CI: 1.37-2.1), >or=8.5 mmol/l, 2.83 (95% CI: 2.3-3.47), P=0.000001], and Glasgow Coma Scale [<15 OR: 1.9 (95% CI: 1.29-2.78); P=0.001] remained significantly associated on multivariate analysis. We constructed a predictive model from these data. Sensitivity, specificity, positive predictive value, and negative predictive value were 89.1, 27.4, 60.4, and 91.7%, respectively.

CONCLUSION

ESR is common in the ED setting. Alcohol consumption, capillary glucose, and abnormal neurological examination on arrival at the ED are associated with increased risk of ESR.