Emergency Department Utilization in Epilepsy Management

Emergency departments play a pivotal role in the acute management of seizures, yet their routine use by people with epilepsy often reflects systemic gaps in chronic care rather than true medical necessity. Patients with known epilepsy frequently attend due to unwitnessed convulsions, fear of complications or lack of rapid community alternatives. These visits impose substantial costs on health services, contribute to crowding and may offer limited benefit to long-term seizure control. Key drivers include variable prehospital decision-making, inconsistent access to patient history, limited paramedic training in seizure assessment and absence of clear referral pathways. International audits reveal wide disparities in admission rates, length of stay and follow-up arrangements, underscoring the need for standardised guidelines and coordinated care pathways that divert non-urgent cases to community or specialist services without compromising safety.

Research from Nature Portfolio

A large retrospective analysis in Germany examined nearly nine thousand emergency service records for seizure events and found that over 90 per cent of patients were conveyed to hospital, yet nearly half of admissions resulted in stays of only one night. Hospitalisation was more likely in older individuals and those receiving higher doses of prehospital medication. The absence of national prehospital guidelines led to precautionary transport decisions, heightening patient distress and inflating costs. The study advocates for evidence-based protocols to guide ambulance crews, improve confidence in on-scene decisions and reduce unnecessary hospital conveyances.

Emergency Department Utilization in Epilepsy Management publication trend

The graph below shows the total number of articles in emergency department utilization in epilepsy management across all publications each year (not limited to Nature Index journals).

Technical terms

Conveyance rate: Proportion of patients transported from the scene of an incident to hospital by emergency services.

Prehospital care: Medical assessment and interventions delivered before arrival at an emergency department.

Alternative care pathway: A structured route for managing patients outside the emergency department, such as community-based follow-up or specialised clinics.

Self-management intervention: A programme designed to enhance patients’ skills and confidence in managing their own condition and reducing reliance on emergency services.

Audit: Systematic review of clinical practice and outcomes against established standards to identify areas for improvement.

References

1. Excessive hospitalization of patients with seizures in the Germany prehospital emergency system: a retrospective cohort study. Scientific Reports (2022).
2. Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1). BMJ Open (2016).
3. Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review. Seizure (2020).
4. Care in Europe after presenting to the emergency department with a seizure; position paper and insights from the European Audit of Seizure Management in Hospitals. European Journal of Neurology (2022).