응급의료센터에서 발작과 실신의 감별 진단을 위한 The Denver Seizure Score의 타당성에 관한 후향적 연구 = A Retrospective Study for Validity of the Denver Seizure Score in Emergency Medical Care Center for Differential Diagnosis of Seizure and Syncope

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 최윤호, "발작과 실신에서 일시적 혈중 암모니아 상승의 차이" 대한신경과학회 30 (30): 279-283, 2012

2 LaFrance WC Jr, "Use of serum prolactin in diagnosing epileptic seizures : report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology" 66 : 1287-1288, 2006

3 Petkar S, "Transient loss of consciousness: summary of NICE guidance" 100 : 350-, 2014

4 Cembrowski GS, "The use of serial patient blood gas, electrolyte and glucose results to derive biologic variation: a new tool to assess the acceptability of intensive care unit testing" 48 : 1447-1454, 2010

5 Bakes KM, "The Denver Seizure Score: anion gap metabolic acidosis predicts generalized seizure" 29 : 1097-1102, 2011

6 Hulme J, "Severe lactic acidosis following alcohol related generalized seizures" 59 : 1228-1230, 2004

7 Lee SY, "Serum neuron-specific enolase level as a biomarker in differential diagnosis of seizure and syncope" 257 : 1708-1712, 2010

8 Petramfar P, "Serum creatine phosphokinase is helpful in distinguishing generalized tonic-clonic seizures from psychogenic nonepileptic seizures and vasovagal syncope" 15 : 330-332, 2009

9 Duponta S, "Seizures in the elderly:Development and validation of a diagnostic algorithm" 89 : 339-348, 2010

10 Britton JW, "Seizures and syncope: anatomic basis and diagnostic considerations" 16 : 18-28, 2006

11 Libman MD, "Seizure vs. syncope: measuring serum creatine kinase in the emergency department" 6 : 408-412, 1991

12 McKeon A, "Seizure versus syncope" 5 : 171-180, 2006

13 Goksu E, "Seizure or syncope : the diagnostic value of serum creatine kinase and myoglobin levels" 16 : 84-86, 2009

14 Quinn J, "Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes" 47 : 448-454, 2006

15 Sarasin FP, "Prospective evaluation of patients with syncope : a population based study" 111 : 177-184, 2001

16 Murray DM, "Persistent lactic acidosis in neonatal hypoxic-ischaemic encephalopathy correlates with EEG grade and electrographic seizure burden" 93 : F183-F186, 2008

17 Kotsopoulos I, "Incidence of epilepsy and predictive factors of epileptic and non-epileptic seizures" 14 : 175-182, 2005

18 Beghi E1, "Incidence and predictors of acute symptomatic seizures after stroke" 77 : 1785-1793, 2011

19 Brivet F, "Hyperchloremic acidosis during grand mal seizure lactic acidosis" 20 : 27-31, 1994

20 Sheldon R, "Historical criteria that distinguish syncope from seizures" 46 : 142-148, 2002

21 Sun BC, "External validation of the San Francisco Syncope Rule" 49 : 420-427, 2007

22 King MA, "Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients" 352 : 1007-1011, 1998

23 Cloyd J, "Epidemiological and medical aspects of epilepsy in the elderly" 68 : 39-48, 2006

24 Umeda A, "Effects of Hyperventilation on Venous-Arterial Bicarbonate Concentration Difference : A Possible Pitfall in Venous Blood Gas Analysis" 5 : 76-80, 2014

25 Sun BC, "Direct medical costs of syncope-related hospitalizations in the United States" 95 : 668-671, 2005

26 Jouny CC, "Characterization of early partial seizure onset : frequency, complexity and entropy" 123 : 658-669, 2012