title: Seizure management at Auckland City Hospital Emergency Department between July and December 2009: time for a change?
abstract: OBJECTIVE
  To assess the management of epileptic seizures and status epilepticus in adult patients at Auckland City Hospital emergency department. This information will form the basis of future seizure management protocols and further research on the management of status epilepticus.
  
  
  METHODS
  The prehospital and acute hospital management of all adult seizure patients seen between 1 July 2009 and 31 December 2009 was reviewed with respect to seizure type, presence of first seizure, pre-existing epilepsy diagnosis and disposition from the emergency department.
  
  
  RESULTS
  Two hundred and fifty-five seizure events were identified in 227 patients. Nineteen patients presented twice during the study period and three patients presented three or more times. Generalised seizures were much more common than focal seizures. There were 75 presentations with first seizure (29.4%). Thirty-seven patients (49.3%) with a first seizure received treatment with an anti-epileptic drug. Status epilepticus occurred on 12 occasions (4.7%) with only three patients receiving lorazepam as treatment. The majority of seizure patients were managed by emergency department staff (58.4%) while general medicine (17.6%) and neurology (11.8%) teams managed fewer patients. Phenytoin was used in 56 patients (22%) with the majority (n= 43) receiving intravenous phenytoin. Many of the patients who received intravenous phenytoin were not subsequently discharged on that medication (46%).
  
  
  CONCLUSIONS
  More patients than would be expected received treatment after their first seizure. Phenytoin was a widely used anti-epileptic drug. There was a wide variability in the management of status epilepticus, and intravenous lorazepam was underutilised.
authors.forename: I
authors.initials: I
authors.lastname: Rosemergy
authors.forename: P
authors.initials: P
authors.lastname: Bergin
authors.forename: P
authors.initials: P
authors.lastname: Jones
authors.forename: E
authors.initials: E
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use; D002220:Carbamazepine / Q000097:blood / Q000627:therapeutic use; D019468:Disease Management; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010348:Patient Care Team; D010672:Phenytoin / Q000097:blood / Q000627:therapeutic use; D012189:Retrospective Studies; D012621:Seasons; D012640:Seizures / Q000453:epidemiology / Q000628:therapy*; D013226:Status Epilepticus / Q000628:therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014635:Valproic Acid / Q000097:blood / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid; D010672:Phenytoin