A Retrospective Study for Validity of the Denver Seizure Score in Emergency Medical Care Center for Differential Diagnosis of Seizure and Syncope

ABSTRACT

PURPOSE: The purpose of this study is to validate the Denver seizure score (DSS) compared with a questionnaire and scoring system for symptoms pertaining to loss of consciousness (QSLOC) in patients with loss of consciousness who visited the emergency department (ED). METHODS: This was an observational study. Patients with loss of consciousness who were admitted from January, 2011, to July, 2013 in an urban ED with approximately 30,000 annual visits were eligible. General characteristics, clinical manifestation, hemodynamic, and laboratory data were collected. DSS and QSLOC were calculated as originally described. The SPSS package with Mann-Whitney U test, Fisher's exact test, and logistic regression was used for analysis of the data. The area under the receiver operating characteristics curve (AUC) was used for discrimination of each score. RESULTS: Based on the historical feature, clinical manifestation, and final diagnosis, the patients were divided into 45 seizure and 52 syncope cases. In the seizure group, there were more males than females (p=0.015) and statistically significant findings were observed for serum bicarbonate (p<0.001), anion gap (p<0.001). AUCs were 0.954 and 0.998 for DSS and QSLOC, respectively. CONCLUSION: Compared to QSLOC, DSS did not show a noticeable difference in differentiating seizure disorder, and for patients who lost consciousness, it can be used in determining procedures and for prediction of both treatment method and prognosis in the emergency department.