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To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure.ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge.Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025).The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure.Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH).ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH.Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,28- 3,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025).El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias. |
