From the Guidelines
The Canadian Triage and Acuity Scale (CTAS) score for a first-time seizure is typically Level 2 (Emergent), indicating that the patient should be seen by a physician within 15 minutes of arrival. This high priority is assigned because a first seizure requires prompt medical evaluation to determine its cause and prevent potential complications, as outlined in the 2024 clinical policy update 1. Patients presenting with a first-time seizure need a thorough neurological assessment, vital sign monitoring, and often laboratory tests including electrolytes, glucose, calcium, and magnesium levels. Neuroimaging such as CT or MRI may be necessary to rule out structural abnormalities. While immediate treatment with antiepileptic drugs is not always required after a single seizure, the physician may consider medication if there are predisposing factors or abnormalities on testing, as suggested by the 2014 clinical policy 1.
The high acuity score reflects the potential for serious underlying conditions such as brain tumors, infections, stroke, or metabolic disturbances that could cause seizures. Additionally, there's always concern about status epilepticus, a medical emergency where seizures are prolonged or recur without recovery of consciousness between episodes. According to the 2014 clinical policy, approximately one third to one half of patients with a first unprovoked seizure will have a recurrent seizure within 5 years 1. However, the 2024 update provides more recent guidance on the management of adult patients presenting to the emergency department with seizures, emphasizing the importance of prompt evaluation and treatment 1.
Key considerations in assigning a CTAS score for a first-time seizure include:
- The need for prompt medical evaluation to determine the cause of the seizure
- The potential for serious underlying conditions that could cause seizures
- The risk of recurrent seizures or status epilepticus
- The importance of thorough neurological assessment, vital sign monitoring, and laboratory tests
- The potential need for neuroimaging or antiepileptic medication, as outlined in the clinical policies 1.
From the Research
CTAS Score for First-Time Seizure
The Canadian Triage and Acuity Scale (CTAS) is a triage system used in emergency departments to prioritize patients based on the severity of their condition. For first-time seizures, the CTAS score can vary depending on the patient's presentation and underlying conditions.
- The decision to assign a CTAS score for a first-time seizure is guided by the patient's history, physical examination, and diagnostic evaluation, as discussed in studies 2, 3, 4, 5, 6.
- Patients with a first-time seizure who have returned to a normal baseline mental status and have no comorbidities or focal neurologic examination may be assigned a lower CTAS score, as they are considered to be at lower risk for complications, as noted in 3.
- In contrast, patients with a first-time seizure who have comorbidities, a focal neurologic examination, or have not returned to a normal baseline mental status require a more extensive diagnostic evaluation and may be assigned a higher CTAS score, as discussed in 2, 3, 4, 5, 6.
- The CTAS score can also be influenced by the presence of risk factors for seizure recurrence, such as EEG epileptiform discharges, brain imaging abnormalities, nocturnal seizures, or prior brain trauma, as identified in 5, 6.
Factors Influencing CTAS Score
Several factors can influence the CTAS score for a first-time seizure, including:
- The patient's underlying medical conditions and comorbidities, as discussed in 2, 3, 4, 5, 6.
- The presence of focal neurologic signs or symptoms, as noted in 3, 4, 5, 6.
- The patient's mental status and level of consciousness, as discussed in 2, 3, 4, 5, 6.
- The presence of risk factors for seizure recurrence, such as EEG epileptiform discharges, brain imaging abnormalities, nocturnal seizures, or prior brain trauma, as identified in 5, 6.