title: Predictors of early seizure recurrence in patients admitted for seizures in the Emergency Department.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Department, Hôpital Universitaire Bichat-Claude Bernard, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Choquet
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Depret-Vassal
authors.forename: Benoit
authors.initials: B
authors.lastname: Doumenc
authors.forename: Sophie
authors.initials: S
authors.lastname: Sarnel
authors.forename: Enrique
authors.initials: E
authors.lastname: Casalino
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D012640:Seizures / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose