Patients with acute head trauma, prolonged alteration of consciousness, and a focal neurologic examination at presentation to the emergency department represent important clinical factors that drive the choice for neuroimaging, according to a study published in Epilepsia.
A total of 822 consecutive emergency department visits for nonindex seizures were retrospectively reviewed. Study investigators collected data on patients’ clinical presentation, whether or not clinicians obtained neuroimaging information, and neuroimaging results, as well as results of prior neuroimaging tests.
Additionally, the investigators sought to detect whether neuroimaging during the emergency department visit was associated with acute changes in the management of patients. A multivariate logistic regression analysis was used to assess clinical factors associated with obtaining neuroimaging during emergency department visit.
Approximately 78% of visits to the emergency department for seizures were for nonindex seizures. In 46% (n=381) of visits, neuroimaging was obtained, of which 11 imaging studies resulted in acute changes in the management of admitted patients. Following exclusion of false-positive scans, approximately 2% (n=8) of imaging studies led to an acute change in the management of patients. Greater neuroimaging yield at emergency department admission was more frequent among patients with acute head trauma, prolonged alteration of consciousness, and a focal neurologic assessment at presentation.
Limitations of the study include the analysis of emergency department visits at mainly urban centers, potentially reducing the applicability of the findings, particularly across rural centers.
The findings from the study “support a more conservative use of emergency department neuroimaging for nonindex seizures, based on clinical factors at the time of presentation.”
Salinsky M, Wong VSS, Motika P, Meuse J, Nguyen J. Emergency department neuroimaging for epileptic seizures [published online July 18, 2018]. Epilepsia. doi: 10.1111/epi.14518