Improving Standardization and Access to Care via Seizure Pathways in the Emergency Department.

Publisher: Department of Emergency Medicine, University of California, Irvine Country of Publication: United States NLM ID: 101476450 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-9018 (Electronic) Linking ISSN: 1936900X NLM ISO Abbreviation: West J Emerg Med Subsets: MEDLINE

Publication: <2011>- : Irvine, CA : Department of Emergency Medicine, University of California, Irvine
Original Publication: Orange, CA : California Chapter of the American Academy of Emergency Medicine

Emergency Service, Hospital*/standards ; Emergency Service, Hospital*/organization & administration ; Emergency Service, Hospital*/statistics & numerical data ; Seizures*/therapy ; Seizures*/diagnosis ; Critical Pathways*/standards ; Health Services Accessibility*/standards; Length of Stay/statistics & numerical data ; Humans ; Female ; Male ; Adult ; Middle Aged ; Retrospective Studies ; Quality Improvement

Introduction: Seizures are one of the most common neurological presentations to an emergency department (ED), often as a first seizure of life or a breakthrough seizure. There is practice variation regarding the diagnostic workup and management for these patient populations. A standardized pathway for emergent evaluation of first seizure of life or breakthrough seizure currently does not exist, resulting in variability in evaluation and timing of outpatient care.
Methods: We created standardized pathways for evaluation and management of patients presenting to the ED with a first seizure of life or breakthrough seizure. These pathways, implemented at a large, quaternary-care hospital system, were utilized on 130 patients presenting with a seizure and compared with all patients with seizure on whom the pathway was not used, between May 2022-October 2023. Outcomes of interest included ED length of stay (LOS), proportion of patients admitted, time to outpatient follow-up, and difference in resource utilization. We compared categorical variables using chi-square test and continuous variables using the Wilcoxon rank-sum test. Equality of variance between the two cohorts was tested using the Levene test.
Results: There was no statistically significant difference between the percentage of male and female patients evaluated via standard-of-care model (45.6% and 49.5%) and those on the pathway (56.9% and 43.1%). The average age of patients was similar between standard-of-care and pathway groups (41 and 39 years, respectively). Median ED LOS was 5.0 (Interquartile range [IQR] 2.9-9.4) hours for standard of care and 4.8 (IQR 3.1-7.0) hours for pathway (P = .34), with a significant difference in variability in time for pathway group (P < .001). Fewer patients were admitted or observed with pathway use (P < .02). Median time to outpatient follow-up was 41.0 days (IQR 17.0-93.0) with standard of care and 23.5 days (IQR 8.0-57.0) with pathway use (P < .001). More urinalyses (P < .001), drug screens (P < .001), alcohol levels (P < .001) and computed tomography for first seizures (P < .001) were ordered for the pathway group. Fewer magnetic resonance imaging studies were ordered for patients in the breakthrough seizures group using the pathway (P < .001).
Conclusion: Standardized pathways to approach seizure presentation in the ED can reduce variability in care, improve time to outpatient neurologic care, and standardize seizure-safety counseling.

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Date Created: 20260119 Date Completed: 20260119 Latest Revision: 20260121

20260130

PMC12815501

10.5811/westjem.48847

41554146