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

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Abstract

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.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

LivaNova USA for an Investigator Initiated Research Grant and Mrs Katherine Eggleston LivaNova USA.

Funding

This research received funding from LivaNova as an investigator-initiated grant.

Author information

Authors and Affiliations

  1. Department of Intellectual Disability Neuropsychiatry, Research Team, Cornwall Partnership NHS Foundation Trust, Truro, TR1 3QB, UK

    Sarah Lennard, Jon Allard, Richard Laugharne & Rohit Shankar

  2. Department of Medical Statistics, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU, UK

    William Henley

  3. Royal Cornwall Hospital NHS Trust, Truro, TR1 3HD, UK

    Brendan McLean, Mary Parrett & Mark Jadav

  4. Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, TR1 3QB, UK

    Sarah Lennard, Brendan McLean, Jon Allard, Richard Laugharne & Rohit Shankar

  5. CIDER Department of Intellectual Disability Neuropsychiatry Cornwall Partnership NHS Foundation Trust, Truro, TR4 9LD, UK

    Rohit Shankar

Authors
  1. Sarah Lennard
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  2. William Henley
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  3. Brendan McLean
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  4. Jon Allard
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  5. Mary Parrett
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  6. Mark Jadav
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  7. Richard Laugharne
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  8. Rohit Shankar
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Contributions

All authors satisfy the ICMJE guidance by substantially contributing to the design, analysis, and interpretation of the work, drafting of the manuscript, final approval of the manuscript and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work is appropriately investigated and resolved.

Corresponding author

Correspondence to Rohit Shankar.

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Conflicts of interest

SL was employed as a result of an investigator-initiated Grant from LivaNova. RS has received institutional and research support from LivaNova both for this project and other projects. In addition, he has received institutional and research support from UCB, Eisai, Veriton Pharma, Bial, Averelle, UnEEG and GW pharma outside the submitted work. He holds grants from NIHR AI, SBRI and other funding bodies all outside this work. JA research salary has been supported by the European Social Fund, UCB, Eisai, and GW pharma for research projects unrelated to this submitted work. BM has received institutional and research support from UCB, Eisai, Biogen, Bial, Roche, GW Pharma and Novartis.

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Lennard, S., Henley, W., McLean, B. et al. Seizures and emergency department: characteristics and factors of repeat adult attendees. J Neurol 269, 3770–3778 (2022). https://doi.org/10.1007/s00415-022-11006-0

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  • DOI: https://doi.org/10.1007/s00415-022-11006-0

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