| Abstract [eng] |
Background. Seizures are a common cause of emergency department visits. Given the hospitalization burden, complication risk, and lack of data in Lithuania, this study aims to better understand seizure etiology, clinical presentation, and factors determining patient outcomes. Aim. To determine the causes, clinical presentation, and outcomes of seizures in the emergency department. Objectives. To determine the etiology, type, and clinical characteristics of seizures in patients presenting to the emergency department; to assess patients' general condition based on physiological parameters; to evaluate the instrumental and laboratory investigations performed; to determine the frequency of hospitalization and status epilepticus and their predictors. Methods. A retrospective analytical study was conducted using anonymized records from the Emergency department of Vilnius University Hospital Santaros klinikos (January 1, 2024 – January 1, 2025). A total of 298 adult patients with ICD-10 diagnoses R56, G40.0–G40.91, G41.0–G41.9 were included. Pearson chi-square, Fisher's exact, Mann-Whitney, Kruskal-Wallis with Dunn tests and binary logistic regression were applied using R with the Rcmdr package. Results. The study comprised 298 patients, median age 51.0 years; 61.4% male. Hospitalization occurred in 65.4%; status epilepticus in 4.4%. The most frequent investigation was computed tomography (86.6%). One third (34.6%) had prior epilepsy; 18.8% presented with a first-ever seizure. Males more often experienced a first seizure (29.1%, p=0.003); hospitalization was more common among females (p=0.046) and older patients (median 57 vs. 43 years, p<0.001). The most common etiology was structural (50.0% of known cases), followed by alcohol-related seizures (20.3%). Generalized seizures accounted for 57.9%, focal for 42.1%. Structural etiology was associated with focal, while alcohol and other etiologies with generalized seizures (p<0.001). Alcohol etiology was associated with younger age, male sex, and first-ever seizure. At least one abnormal physiological parameter was found in 76.5%. The most frequent laboratory abnormalities were hepatic (36.6%) and renal dysfunction (27.4%). First-ever seizure was associated with 3.4-fold lower hospitalization probability (OR=0.29; 95% CI 0.14–0.57; p<0.001), while renal dysfunction with 2.6-fold higher probability (OR=2.64; 95% CI 1.23–6.02; p=0.016). Status epilepticus occurred more frequently in focal seizures (p=0.012). Conclusions. The most common seizure causes were structural and alcohol-related etiologies. Structural seizures presented as focal, alcohol-related as generalized. Younger males more often experienced first-ever seizures, commonly associated with alcohol. The most frequent investigation was computed tomography. Independent hospitalization predictors were renal dysfunction and first-ever seizure. Status epilepticus was more frequent in focal seizures. |
