Sindujaa S N, Elamurugan T P, Ajay P
Most seizure-related injuries among patients presenting to the ED were isolated soft tissue injuries; however, nearly one-third were major seizure-related injuries. Seizure-related road traffic accidents and frequent seizures independently predicted major injury. Although seizure frequency showed significant associations, the wide confidence intervals indicate limited precision and warrant cautious interpretation. Early identification of high-risk patients may facilitate timely trauma assessment, optimization of epilepsy management, and targeted injury-prevention strategies.
BACKGROUND: Seizure-related injuries (SRIs) are a common cause of emergency department (ED) visits and contribute substantially to morbidity among people with epilepsy. Although several studies have described the overall burden of SRIs, prospective data evaluating predictors of major seizure-related injuries among patients presenting to the ED remain limited, particularly in low- and middle-income countries.
OBJECTIVE: To describe the clinical characteristics and injury patterns of seizure-related injuries and identify predictors of major seizure-related injuries among patients with epilepsy presenting to the ED.
METHODS: We conducted a prospective observational study of consecutive adults presenting with seizure-related injuries to the ED of a tertiary care teaching hospital in South India between July 2022 and December 2023. Clinical characteristics, seizure-related variables, injury patterns, and mechanisms of injury were prospectively recorded. All patients were included in the descriptive analysis. Major seizure-related injury was defined as the presence of a fracture, intracranial injury, dislocation, or burn. Predictors of major seizure-related injuries were evaluated only among patients with epilepsy using multivariable binary logistic regression.
RESULTS: During the 18-month study period, 2506 adults presented with seizures, of whom 177 (7.1%) sustained seizure-related injuries. Epilepsy accounted for 130 (73.4%) cases, while 47 (26.6%) had acute symptomatic seizures. Isolated soft tissue injuries were the most common injury pattern (68.9%), whereas 55 (31.1%) patients sustained major injuries. Among these, fractures (15.8%), intracranial injuries (11.9%), dislocations (3.4%), and burns (2.3%) were reported; these categories were not mutually exclusive. After adjustment for potential confounders, seizure-related road traffic accidents (adjusted OR 16.27, 95% CI 6.03-43.90; p < 0.001) and seizure frequency of 1-3 episodes/year (adjusted OR 11.67, 95% CI 1.78-76.50; p = 0.010) and >3 episodes/year (adjusted OR 6.60, 95% CI 1.16-38.12; p = 0.033) independently predicted major seizure-related injuries. The wide confidence intervals for seizure-frequency categories indicate limited precision of these estimates, likely related to the relatively small number of patients and major injury events in the epilepsy subgroup. Recent alcohol intake was not independently associated with major injury after adjustment.
CONCLUSION: Most seizure-related injuries among patients presenting to the ED were isolated soft tissue injuries; however, nearly one-third were major seizure-related injuries. Seizure-related road traffic accidents and frequent seizures independently predicted major injury. Although seizure frequency showed significant associations, the wide confidence intervals indicate limited precision and warrant cautious interpretation. Early identification of high-risk patients may facilitate timely trauma assessment, optimization of epilepsy management, and targeted injury-prevention strategies.