When Should Imaging Be Ordered For Seizures?

Emergency department visits for patients with seizures often have them undergoing neuroimaging, typically CT scans. Imaging in adult patients presenting with onset index seizures leads to a change in care for 9 to 17% of patients, however if any changes are made following imaging in the emergency department for seizures among adults with known seizure disorders is uncertain.

An Epilepsia study involving 822 emergency department visits for non-index seizures showed that neuroimaging was performed in 46% of all patients; of these 3% of imaging tests led to an acute change in patient management, 2% after excluding false positive scans. Each visit researchers abstracted details of clinical presentation, whether imaging was obtained and results, as well as results of previous imaging when available to determine if emergency department neuroimaging led to acute change in patient management. Factors associated with obtaining the imaging and yield of imaging were evaluated by multivariate logistic regression.

Increased yield of emergency department neuroimaging was associated with prolonged alteration of consciousness, acute head trauma, and a focal neurological examination at time of presentation. Without any of these three clinical factors true positive yield of neuroimaging was zero, according to the researchers.

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Researchers say findings suggest a more conservative use of emergency department neuroimaging for non-index seizures is supported, based in clinical factors at time of presentation.