An Audit of the management of a First Afebrile Seizure in childhood. Boyle MA, Chuckwu J, Boyle MC, Connolly A, Webb D. Paediatric Neurology Development The National Children’s Hospital, Dublin, Ireland. INTRODUCTION Afebrile seizure is a common presentation to paediatric emergency departments. International guidelines on management of such presentations allow for judicious use of imaging and appropriate investigations. RESULTS JUNE 07 – DEC 08 26 Children. 13 boys, 13 girls Age range from 1 month to 13yrs Average age 7 yrs No case achieved full concordance with the devised standards Average score was 13 (Range 5 -17) History well documented – avg score 2 (of 3) Seizures were well documented – avg score 6 (of 8) 75% concordance w guidelines. Investigation compliance was poor – 53% avg score 4.26 (of 8) Concordance with management at discharge standards, poor at 25% - avg score 0.7 (of 3) JAN 10 – JUNE 10 14 children. 8 boys, 6 girls Age range from 6 months to 13yrs Average age 4.8yrs No case achieved full concordance with devised standards Average score 16 (Range 13 – 20) History well documented avg score 2 (of 3) Seizures were well described – avg 7.7 (of 8) (97% concordance) Compliance with guidelines on investigation of the first afebrile seizure in childhood improved – avg 5.6 (of 8) ~70% concordance Concordance with management at discharge standards, avg 1.3 (43% concordance) NICE Guidelines 2004 Review by specialist in management of epilepsies to ensure precise & early diagnosis EEG – to support a dx of epilepsy. Neuroimaging – not routinely MRI > CT. Of most value in under 2’s, history suggestive of focal onset, seizure’s persist after 1st line tx. Blds & Urine biochem - discretion of specialist AAN GUIDELINES 2003 Labs U&E/bld glu/Mg/Ca/FBC – intuitive, evidence for same not strong Labs – guided by case and hx. Glu, Ca and U&E most important EEG – standard recommendation. NeuroImaging – not routine. OBJECTIVE To compare the management of first Afebrile seizures with internationally recognized standards in an Irish tertiary paediatric setting. Score CONCLUSION Presentation with first afebrile seizures is common in childhood. We have demonstrated a lack of concordance with international guidelines on management of the first afebrile seizure in our institution. Improvement noted between the 2 periods especially in area of investigation and discharge management. Discharge management and advice remains poor with often no documentation regarding use of rescue meds or safety precautions. Investigation improvements in area of requesting EEG on first event and improvement in the appropriate use of imaging We now intend to provide further guidance on this topic and introduce an information pack at discharge before repeating the audit cycle. METHODS Records of first afebrile seizure presenting to a Paediatric Emergency Department period between June 2007 and December 2008 were identified through interrogation of emergency department admission books and Paediatric ward ledgers. Infants older than one month up to over 15 years were included Management standards were devised from a compilation of British (NICE 2004)1 and North American (AAN 2003)2 guidelines. The standards comprised 3 principle areas: (i) the medical record and seizure documentation (ii) investigations recorded and (iii) documentation of management at discharge. Complete concordance with the standards would accrue a score of 21/21. Relevant patient charts were reviewed, assessing medical and nursing notes. The audit was repeated over the period Jan to June 2010. Patients REFERENCES The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. CG20. www.nice.org.uk Practice parameter: Evaluating a first nonfebrile seizure in children. Hirtz D et al. NEUROLOGY 2000;55:616–623