Short-term outcome of seizure patients who refuse transport after out-of-hospital evaluation.
OBJECTIVE
To determine the short-term outcome of patients with a known seizure disorder who have a seizure, are evaluated by out-of-hospital care providers, and refuse transport.


METHODS
This was a prospective study conducted over a 15-month period. Philadelphia Fire Department paramedics contacted a medical command physician whenever they encountered a patient with a known seizure disorder who had had another seizure and was refusing transport. After confirming that the patient had the mental capacity to refuse care and understood the associated risks, the physician recorded the patient's name, address, and telephone number. Beginning three days later, a registered nurse attempted to reach the patient by telephone and administer a brief questionnaire about his or her medical outcome. Patients not reached by telephone were sent a certified letter. The names of patients lost to follow-up were compared with medical examiner records to confirm that they had not died during the follow-up period.


RESULTS
Of 63 patients enrolled in the study, 52 (82.5%) were reached in follow-up. Of these, three (5.8%) had another seizure within 72 hours and recontacted 911. One of these patients (1.9%) was hospitalized. Twenty (38.5%) patients contacted their primary care physicians. There were no deaths, including patients lost to follow-up.


CONCLUSIONS
Most patients (94.2%) who were evaluated by out-of-hospital care providers for a seizure and refused transport had no further seizure activity in the subsequent 72 hours. However, because there is a risk of recurrence, out-of-hospital care providers and medical command physicians should ensure that patients understand the risks of refusal.
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. mechemc@mail.med.upenn.edu
C C
CC
Mechem
J
J
Barger
F S
FS
Shofer
E T
ET
Dickinson
D000328:Adult; D000553:Ambulatory Care / Q000523:psychology*; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D010358:Patient Participation / Q000523:psychology; D011446:Prospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D012640:Seizures / Q000473:pathology / Q000523:psychology*; D014187:Transportation of Patients; D016312:Treatment Refusal / Q000523:psychology*