Determining the need for admission in patients with new-onset seizures.
OBJECTIVE
To determine which adult patients with new-onset seizures require admission and whether those who require admission can be identified in the emergency department.


METHODS
Retrospective chart review of patients seen during a 5-year period.


METHODS
Urban county teaching hospital in southern California.


METHODS
Three hundred thirty-three adult patients with new-onset seizures. Patients were excluded if they had acute head trauma, hypoglycemia from diabetic therapy, or alcohol- or recreational drug-related seizures.


METHODS
Standardized medical evaluation including physical examination, CBC, SMA-7 (electrolytes, blood urea nitrogen, creatinine, glucose), calcium, cranial computed tomography (CT), lumbar puncture if indicated, and admission to the hospital.


RESULTS
Forty-six percent of patients (136 of 294) admitted to our hospital required admission as judged by a retrospective evaluation of the ED and hospital course. The numbers of patients who had a clinically significant result with each part of the evaluation were: physical examination, 75 of 333 (23%); CBC, 25 of 319 (8%); SMA-7, 21 of 329 (6%); calcium, 2 of 208 (1%); CT, 134 of 325 (41%); and lumbar puncture, 19 of 227 (8%). Ninety-five percent of patients requiring admission (129 of 136) were detected by the standardized medical evaluation.


CONCLUSIONS
One half of patients with new-onset seizures require admission. Patients with new-onset seizures who require admission can usually be detected by a standardized medical evaluation in the ED.
Henneman
P L
PL
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance.
DeRoos
F
F
Lewis
R J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002493:Central Nervous System Diseases / Q000150:complications / Q000175:diagnosis; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009443:Neuritis / Q000150:complications / Q000175:diagnosis; D010343:Patient Admission / Q000592:standards*; D012008:Recurrence; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology*; D013226:Status Epilepticus / Q000175:diagnosis