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  • Best Evidence Topic report: Is a CT head required for patients who present to the emergency department with a first seizure?

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Best Evidence Topic reports
Best Evidence Topic report: Is a CT head required for patients who present to the emergency department with a first seizure?
  1. Callum Williams,
  2. Gregory Yates
  1. Emergency Department, Manchester Royal Infirmary, Manchester, UK
  1. Correspondence to Callum Williams; callum.williams{at}doctors.org.uk

Abstract

A short systematic review was undertaken to assess whether adult patients presenting to the ED with a first seizure require a CT head scan to rule out emergent intracranial pathology. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. Seven relevant papers were identified. Study information, patient characteristics, key results and methodological weaknesses were tabulated. Our results indicate that adults presenting with a first seizure are a high-yield group for CT with a number needed to scan (NNS) between 10 and 19 for findings that would change management in ED, such as haemorrhage, infarction and tumours. We believe that this NNS is sufficiently low to justify the routine use of neuroimaging for these patients in emergency care.

  • emergency department
  • Computed tomography

https://doi.org/10.1136/emermed-2024-214189

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    Footnotes

    • Handling editor Richard Body

    • X @cmwilliams99

    • Correction notice Since this paper first published, a disclaimer statement has been added.

    • Contributors CW and GY contributed equally to the study design, search process, data extraction and drafting of the initial manuscript. Both authors have reviewed and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. This BET was first published on the BestBETs website at http://www.bestbets.org and has been reproduced with permission.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.