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Seizure vs. syncope

Measuring serum creatine kinase in the emergency department

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Abstract

Objective:To determine the utility of serum creatine kinase measurement for diagnosing generalized tonic-clonic seizures in patients presenting to an emergency department with transient loss of consciousness.

Design:Prospective evaluation of a diagnostic parameter. Retrospective data collection with blinded assignment to diagnostic groups.

Setting:University teaching hospital.

Patients:Sequential sample of 205 patients with transient loss of consciousness. The study group consisted of 96 patients who had creatine kinase measurements in the emergency department.

Measurements and main results:An investigator blinded to the results of creatine kinase measurements retrospectively classified events into seizure and nonseizure groups on the basis of clinical presentation, prior history, and follow-up investigations. Mean (±SE) creatine kinase level was significantly higher in the seizure group (231.1±34.8 U/L vs. 70.5±5.6 U/L, p<0.001). Elevated creatine kinase had a test specificity of 0.98 (95% CI 0.90–1.00) and a sensitivity of 0.43 (95% CI 0.28–0.59). The discriminating power of creatine kinase elevation was directly related to the time interval between the event and testing (p<0.0001). Among samples taken more than three hours after the event, test sensitivity was 0.80 (0.52–1.00) and specificity was 0.94 (0.71–1.00).

Conclusion:Creatine kinase may be a useful test for evaluating patients with transient loss of consciousness. The test is highly specific for diagnosing generalized seizures in the emergency department. Test sensitivity improves by sampling serum at least three hours after the event.

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Authors and Affiliations

  1. the Division of General Internal Medicine, McGill University, Montreal, Quebec, Canada

    Michael D. Libman MD &  Steven A. Grover MD, MPA

  2. the Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada

    Louise Potvin PhD, Louis Coupal BSc &  Steven A. Grover MD, MPA

  3. Montreal General Hospital, and the Department of Medicine, McGill University, Montreal, Quebec, Canada

    Michael D. Libman MD &  Steven A. Grover MD, MPA

  4. the Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

    Louise Potvin PhD &  Steven A. Grover MD, MPA

Authors
  1. Michael D. Libman MD
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  2. Louise Potvin PhD
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  3. Louis Coupal BSc
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  4. Steven A. Grover MD, MPA
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Additional information

Dr. Potvin performed this work while a postdoctoral fellow supported by the Fonds de la recherche en santé du Québec and is currently located at the Groupe de recherche interdisciplinaire en santé (GRIS) at l’Université de Montréal. Dr. Grover is a research scholar supported by the Fonds de la recherche en santé du Québec.

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Libman, M.D., Potvin, L., Coupal, L. et al. Seizure vs. syncope. J Gen Intern Med 6, 408–412 (1991). https://doi.org/10.1007/BF02598161

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