Seizure Leading to Hospital Presentation: Does a Period of Inpatient Observation Reduce Hospital Readmission Rates?

AIM: Seizures are a common presentation to the Emergency Department, accounting for 3% of all attendances. Despite this, there are currently no evidence-based guidelines on the criteria for safe discharge in patients presenting with seizures, and clinical practice varies significantly. Standard practice includes keeping patients for a period of seizure-free observation before discharge. We looked to identify if the duration of the seizure-free observation impacts hospital readmission for seizures. METHODS: We conducted a retrospective cohort study at a South-West London University Hospital ED, analysing 404 patients presenting with seizures over 12 months. Data collected included demographics, seizure-free time before discharge and readmission with seizure at any point within 12 months. Patients were grouped by "seizure-free" time into 0-4 h,4-8, 8-16, 16-24, 24-32, 32-40, 40-48 and 48+ hours seizure-free before discharge. RESULTS: Seizure-free observation for any duration was not associated with increased risk of hospital readmission. There was no association between seizure-free observation time and risk of readmission with seizures during the study period compared to patients observed for <4 h. CONCLUSION: A seizure-free observation period longer than 4 h does not reduce the risk of hospital readmission and is unlikely to be helpful as a discriminator in the decision to discharge patients presenting with seizures.