Document Detail

Short-term outcome of seizure patients who refuse transport after out-of-hospital evaluation.
MedLine Citation:
PMID:  11229944     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the short-term outcome of patients with a known seizure disorder who have a seizure, are evaluated by out-of-hospital care providers, and refuse transport. METHODS: This was a prospective study conducted over a 15-month period. Philadelphia Fire Department paramedics contacted a medical command physician whenever they encountered a patient with a known seizure disorder who had had another seizure and was refusing transport. After confirming that the patient had the mental capacity to refuse care and understood the associated risks, the physician recorded the patient's name, address, and telephone number. Beginning three days later, a registered nurse attempted to reach the patient by telephone and administer a brief questionnaire about his or her medical outcome. Patients not reached by telephone were sent a certified letter. The names of patients lost to follow-up were compared with medical examiner records to confirm that they had not died during the follow-up period. RESULTS: Of 63 patients enrolled in the study, 52 (82.5%) were reached in follow-up. Of these, three (5.8%) had another seizure within 72 hours and recontacted 911. One of these patients (1.9%) was hospitalized. Twenty (38.5%) patients contacted their primary care physicians. There were no deaths, including patients lost to follow-up. CONCLUSIONS: Most patients (94.2%) who were evaluated by out-of-hospital care providers for a seizure and refused transport had no further seizure activity in the subsequent 72 hours. However, because there is a risk of recurrence, out-of-hospital care providers and medical command physicians should ensure that patients understand the risks of refusal.
C C Mechem; J Barger; F S Shofer; E T Dickinson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  8     ISSN:  1069-6563     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-03-20     Completed Date:  2001-05-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  231-6     Citation Subset:  IM    
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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MeSH Terms
Ambulatory Care / psychology*
Decision Making
Evaluation Studies as Topic
Follow-Up Studies
Outcome Assessment (Health Care)
Patient Participation / psychology
Prospective Studies
Recurrence / prevention & control
Risk Assessment
Seizures / pathology,  psychology*
Transportation of Patients
Treatment Refusal / psychology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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