Bakes et al reported the Denber Seizure Score to distinguish generalized seizures from syncope in patients presenting to the Emergency Department with a loss of consciousness. The authors are from Denver Health Medical Center, University of Colorado at Denver, St. Louis University and Providence Everett Medical Center in Everett, Washington.
Patient selection: loss of consciousness
Outcome: seizure vs syncope
Parameters:
(1) serum bicarbonate in mmol/L
(2) serum anion gap in mmol/L
Denver seizure score =
= (2 * ((anion gap) - 12)) + (24 - (bicarbonate))
Score
Likelihood of Generalized Seizure
< 0
low
0 to 20
intermediate
> 20
high
According to Figure 1:
(1) an anion gap > 22 mmol/L is seen with seizures
(2) an anion gap from 17 to 22 mmol/L favors seizures, especially if the bicarbonate is <= 20 mmol/L
(3) an anion gap from 12 to 17 mmol/L favors syncope
(4) an anion gap < 12 mmol/L indicates syncope in most cases.
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