A retrospective study of CT scan utilization in the emergency department for patients presenting with seizures

The indications for neuroimaging in emergency department (ED) patients presenting with seizures have not been clearly defined. In this study, we aimed to investigate the findings that may influence the emergency management of patients with seizures undergoing brain computed tomography (CT) and the factors that influence these findings.

This is a retrospective, single-center study. Patients presenting to the ED with seizures-both patients with diagnosed epilepsy and patients with first-time seizures-who underwent brain CT were included. Demographic information and indications for CT scans were recorded. According to the CT findings, patients were classified as having or not having significant pathology, and comparisons were made. Intracranial mass, intraparenchymal, subdural, and subarachnoid hemorrhage, fracture, and cerebral edema were considered significant pathologies.

This study included 404 patients. The most common reason for a CT scan was head trauma. A significant pathology was found on the CT scan in 5.4% of the patients. A regression analysis showed that hypertension, malignancy, and a prolonged postictal state were the predictive factors for significant pathology on CT.

CT scanning of patients presenting to the ED with seizures has a limited impact on emergency patient management. Clinical decision-making guidelines for emergency CT scanning of patients with seizures need to be reviewed and improved to identify zero/near-zero risk patients for whom imaging can be deferred.