Predictors of Seizure Identified Among Patients With Inpatient Stroke Codes

The authors of a new study that was presented at the American Neurological Association’s 145th Annual Meeting have identified potential predictors of seizure among individuals with an inpatient stroke code (ISC).

These findings emerged from a retrospective analysis (N = 211) approved by an institutional review board. The researchers assessed all ISCs from March 2017 to May 2018. Chart review, diagnosis code, and electroencephalogram (EEG) findings were used to identify patients with a seizure diagnosis, and these patients were compared with all other patients.

Demographics, comorbidities, and potential clinical risk factors were among the variables of interest among the study population. Continuous data were assessed via Wilcoxon Ranked Sum tests, and categorical data were examined using chi-square tests of proportion, or Fisher’s Exact test in the event of low expected frequencies.

Of 211 inpatient stroke codes, 21 patients with a seizure diagnosis, 75 patients with a stroke diagnosis, and 115 patients with other diagnoses were identified. The results of the study indicated that patients with seizure tended to have the following characteristics:

  • Younger age, with a median age of 66 years vs 72 years
  • Shorter time since the patient was last seen normal (15 minutes vs 60 minutes)
  • Greater likelihood of reduced consciousness (85.7% vs 61.1%)
  • Unconsciousness (61.9% vs 11.6%)
  • Gaze deviation (28.6% vs 5.8%)
  • Aphasia (76.2% vs 43.7%)
  • Motor weakness (81% vs 56.3%)

The researchers noted that 0 of 21 patients with a seizure diagnosis had an acute stroke based on imaging. None of the following factors were found to predict seizure: gender, dialysis within 6 hours, diabetes, antiplatelet therapy, sedative use, elevated level of care, dysarthria, neglect, sensory symptoms, facial droop, ataxia, dizziness, blood pressure, and blood glucose abnormalities.

“This data will guide future improvement projects with goals of making rapid correct diagnosis, guide appropriate response and treatment, and ultimately improve outcomes of hospitalized patients with acute neurological event,” they concluded.

—Christina Vogt

Reference:
Emmerson D, Topiwala K, Knopf L, Schuyler E. Risk factors for diagnosis of seizure in the inpatient stroke code population.
Ann Neurol. 2020;88(Suppl. 20). doi:10.1002/ana.25865