New-onset seizures in emergency department: etiological profile and mortality outcome

Abstract Background Studying the clinical and etiological profiles of new-onset seizures (NOS) is crucial for improving treatment and prognosis. This study aimed to determine the etiological profile and clinical characteristics of patients presenting with NOS in the emergency department (ED) of a major tertiary-care university Hospital, and to assess morbidity and mortality outcomes. For this purpose, patients with NOS, either acute or remote symptomatic seizures, with or without SE, who attended the ED were prospectively evaluated. A comparison was made between acute and remote symptomatic seizures regarding clinical and neuro-radiological data. Multiple stepwise logistic regressions were conducted to identify significant predictors of mortality. Results The study included 173 patients presenting with NOS, divided into two groups: those with acute symptomatic seizures ( n = 131, 75.7%) and those with remote symptomatic seizures ( n = 42, 24.3%). The most common cause of NOS was vascular etiology ( n = 89, 52%), which was significantly higher in acute symptomatic cases (73, 55.7%) compared to remote symptomatic cases (16, 38.1%) ( P < 0.001). Metabolic derangement and systemic infections were the second most common causes of NOS. The overall mortality was 27%. The regression model revealed the following predictors of mortality: higher ACCI {OR = 1.262, 95% CI (1.070–1.488)}, SE on presentation{OR = 9.746, 95% CI (3.237–29.344)}, and lower consciousness level assessed by FOUR score {OR = 0.636, 95% CI (0.536–0.753)}. Conclusion Vascular-related causes were the most common of NOS in the ED. High comorbidity burden, SE on presentation, and the lower consciousness level are independent predictors of death, necessitating timely evaluation of such patients to minimize mortality outcomes.