Are spinal precautions necessary in all seizure patients?

The purpose of this retrospective chart review study was to evaluate the necessity of spinal precautions in uncomplicated seizure patients. The population was all patients from the Emergency Department with a primary diagnosis of seizure over a 10.5-year period. The setting was a university-affiliated county teaching hospital with an annual patient volume of over 58,000. The key outcome measure was an association of spinal injuries to uncomplicated seizures. A total of 1,656 cases were reviewed. No spinal injuries were found. Three nonspinal fractures were associated with seizure activity. Transportation costs increased approximately 113% and nursing costs increased approximately 57% for patients with seizure placed in spinal precautions. Quality Assurance and Risk Management files showed no complaints or litigation secondary to missed spinal injuries. This retrospective chart review study seriously questions routine use of spinal precautions in uncomplicated seizure cases. If spinal precautions were not used in this group, there would be a significant potential cost savings without increased morbidity. A prospective study is needed to confirm these findings.