• Am J Emerg Med · Nov 2011

    The Denver Seizure Score: anion gap metabolic acidosis predicts generalized seizure.

    • Katherine M Bakes, Jeff Faragher, Vince J Markovchick, Kevin Donahoe, and Jason S Haukoos.
    • Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA. katherine.bakes@dhha.org
    • Am J Emerg Med. 2011 Nov 1;29(9):1097-102.

    ObjectivesAnion gap (AG) and serum bicarbonate concentration (BICARB) may help confirm a diagnosis of seizure in an unwitnessed collapse; however, little data exist to support this practice. Our objective was to assess the association between AG metabolic acidosis and generalized seizure and to derive a simple score to predict seizure.MethodsThis was a case-control study at an urban teaching hospital. Patients transported to our emergency department with witnessed loss of consciousness and final confirmed diagnoses of generalized seizure (cases) or syncope (controls) were eligible for enrollment. Multivariable logistic regression analysis was used to model associations between AG, BICARB, and seizure.ResultsIn 49 cases and 40 controls, patients in the seizure group were more likely to have a lower median BICARB (17 [range, 14-34] vs 23 [range, 20-24], P < .0001) and a higher median AG (22 [range, 9-42] vs 13 [range, 7-21], P < .0001). The Denver Seizure Score was defined, using regression coefficient weighting, as the Δ BICARB plus twice the Δ AG [(24 - BICARB) + (2×(AG - 12))]. The score ranged from -16 to +74 and identified patients as low likelihood (score <0), moderate likelihood (score 0-20), or high likelihood (score >20), with 21% (95% confidence interval [CI], 5%-51%), 40% (95% CI, 26%-56%), and 96% (95% CI, 82%-100%) being categorized as seizure, respectively.ConclusionsAnion gap metabolic acidosis is associated with generalized seizure. A Denver Seizure Score greater than 20 predicts generalized seizure in the emergency department and may be useful for differentiating patients with unwitnessed loss of consciousness.Copyright © 2011. Published by Elsevier Inc.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…