Seizures and emergency department: characteristics and factors of repeat adult attendees

Background To identify risk factors and characteristics for the repeated attendance at an emergency department (ED) following a seizure. Methods A retrospective cohort study was conducted using non-identifiable data of individuals attending ED at least twice between 2015 and 2018, following a seizure. Data were drawn from the patient administration system of an English rural medium-sized teaching district general hospital emergency department (ED), serving a population of 566,000 people. It was analysed for bio-psycho-social features associated with repeat attendances. Results Of 3522 seizure-related attendances in the four years, 450 people were identified to be repeaters attending on two or more occasions (range 2-12). Just over a quarter (27%) were 18-29 years old. Higher likelihood of re-attendance was associated with social deprivation and no fixed abode. Mental illness was a significant co-morbidity influencing repeat attendances. Nearly half (47%) had no recorded anti-seizure medication (ASM). Three fifth (60%) were on general medication and a quarter (25%) on psychotropics. Nearly a quarter (22%) had alcohol and recreational drug concerns. Just over a quarter (28%) had no previous epilepsy diagnosis. Nearly a fifth (n = 85, 19%) died during the study period. Conclusion People who present repeatedly with seizures at ED are at significant risk of death over a four-year period and require pro-active clinical follow-up. People who are homeless or from socially deprived areas are over-represented in this group, as are those with alcohol problems, co-morbid mental health conditions and compliance issues. This suggests enhanced targeted intervention for this cohort is needed.

Automated summary

This study aimed to identify risk factors and characteristics for the repeated attendance at an emergency department (ED) following a seizure. The study found that patients who presented repeatedly with seizures at ED were at significant risk of death over a four-year period and required proactive clinical follow-up. Patients who were homeless, from socially deprived areas, had alcohol problems, co-morbid mental health conditions, and compliance issues were over-represented in this group, suggesting the need for enhanced targeted intervention for this cohort.