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When Should Emergency Departments Order Imaging Tests for Epileptic Seizures?

Patients who go to the emergency department (ED) with seizures often undergo neuroimaging, usually CT scans. Such imaging in adults presenting with new onset (‘index’) seizures leads to a change in care for 9-17% of patients, but it’s unclear if such changes are made following imaging in the ED for seizures in adults with known seizure disorders (‘non-index’ seizures).

Wednesday, July 18, 2018 12:01 am EDT

Patients who go to the emergency department (ED) with seizures often undergo neuroimaging, usually CT scans. Such imaging in adults presenting with new onset (‘index’) seizures leads to a change in care for 9-17% of patients, but it’s unclear if such changes are made following imaging in the ED for seizures in adults with known seizure disorders (‘non-index’ seizures).

In an Epilepsia study of 822 ED visits for non-index seizures, neuroimaging was performed in nearly half of all patients. Of these, 3% of imaging tests led to an acute change in patient management, 2% after excluding false positive scans. Acute head trauma, prolonged alteration of consciousness, and a focal neurological examination at presentation were associated with an increased yield of ED neuroimaging. Without any of these three clinical factors, the true positive yield of neuroimaging was zero.

The findings support a more conservative use of ED neuroimaging for non-index seizures, based on clinical factors at the time of presentation.

Additional Information

Link to Study: https://onlinelibrary.wiley.com/doi/10.1111/epi.14518

About Journal

Epilepsia is the leading, most authoritative source for current clinical and research results on all aspects of epilepsy. As the journal of the International League Against Epilepsy, Epilepsia presents subscribers with scientific evidence and clinical methodology in:

  • clinical neurology,
  • neurophysiology,
  • molecular biology,
  • neuroimaging,
  • neurochemistry,
  • neurosurgery,
  • pharmacology,
  • neuroepidemiology,
  • therapeutic trials.

Each monthly issue features original peer reviewed articles, brief communications, editorial commentaries, meeting reports, and announcements.  

About Wiley 

Wiley, a global research and learning company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 210 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at www.wiley.com.


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