National audit of pathways in epileptic seizure referrals (NAPIER): A national, multicentre audit of first seizure clinics throughout the UK and Ireland.
Epilepsy
First seizure
First seizure clinic
Seizure
Seizure mimic
Journal
Seizure
ISSN: 1532-2688
Titre abrégé: Seizure
Pays: England
ID NLM: 9306979
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
08
06
2023
revised:
28
07
2023
accepted:
18
08
2023
pubmed:
29
8
2023
medline:
29
8
2023
entrez:
28
8
2023
Statut:
ppublish
Résumé
Current guidelines set clinical standards for the management of suspected first seizures and epilepsy. We aimed to assess if these standards are being met across first seizure clinics nationally, to describe variations in care and identify opportunities for service delivery improvement. Multicentre audit assessing the care of adults (≥16 years) referred to first seizure clinics from 31st December 2019 going backwards (30 consecutive patients per centre). Patients with pre-existing diagnosis of epilepsy were excluded. Anonymised referral, clinic, and follow-up data are reported with descriptive statistics. Data provided for 727 patients from 25 hospitals in the UK and Ireland (median age 41 years [IQR 26-59], 52% males). Median time to review was 48 days (IQR 26-86), with 13.8% (IQR 3.3%-24.0%) of patients assessed within 2 weeks. Seizure recurrence was seen in 12.7% (IQR 6.6%-17.4%) of patients awaiting first appointment. Documentation for witness accounts and driving advice was evident in 85.0% (IQR 74.0%-100%) and 79.7% (IQR 71.2%-96.4%) of first seizure/epilepsy patients, respectively. At first appointment, discussion of sudden unexpected death in epilepsy was documented in 30.1% (IQR 0%-42.5%) of patients diagnosed with epilepsy. In epilepsy patients, median time to MRI neuroimaging was 37 days [IQR 22-56] and EEG was 30 days [IQR 19-47]. 30.4% ([IQR 0%-59.5%]) of epilepsy patients were referred to epilepsy nurse specialists. There is variability nationally in the documented care of patients referred to first seizure clinics. Many patients are facing delays to assessment with epilepsy specialists with likely subsequent impact on further management.
Sections du résumé
BACKGROUND
BACKGROUND
Current guidelines set clinical standards for the management of suspected first seizures and epilepsy. We aimed to assess if these standards are being met across first seizure clinics nationally, to describe variations in care and identify opportunities for service delivery improvement.
METHODS
METHODS
Multicentre audit assessing the care of adults (≥16 years) referred to first seizure clinics from 31st December 2019 going backwards (30 consecutive patients per centre). Patients with pre-existing diagnosis of epilepsy were excluded. Anonymised referral, clinic, and follow-up data are reported with descriptive statistics.
RESULTS
RESULTS
Data provided for 727 patients from 25 hospitals in the UK and Ireland (median age 41 years [IQR 26-59], 52% males). Median time to review was 48 days (IQR 26-86), with 13.8% (IQR 3.3%-24.0%) of patients assessed within 2 weeks. Seizure recurrence was seen in 12.7% (IQR 6.6%-17.4%) of patients awaiting first appointment. Documentation for witness accounts and driving advice was evident in 85.0% (IQR 74.0%-100%) and 79.7% (IQR 71.2%-96.4%) of first seizure/epilepsy patients, respectively. At first appointment, discussion of sudden unexpected death in epilepsy was documented in 30.1% (IQR 0%-42.5%) of patients diagnosed with epilepsy. In epilepsy patients, median time to MRI neuroimaging was 37 days [IQR 22-56] and EEG was 30 days [IQR 19-47]. 30.4% ([IQR 0%-59.5%]) of epilepsy patients were referred to epilepsy nurse specialists.
CONCLUSIONS
CONCLUSIONS
There is variability nationally in the documented care of patients referred to first seizure clinics. Many patients are facing delays to assessment with epilepsy specialists with likely subsequent impact on further management.
Identifiants
pubmed: 37639958
pii: S1059-1311(23)00225-X
doi: 10.1016/j.seizure.2023.08.010
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
165-171Investigateurs
Ajitesh Anand
(A)
Alena Abraham
(A)
Alex Irving
(A)
Amogh Prabhakar
(A)
Catinca Ciuculete
(C)
Cindy Zheng
(C)
Daniel King
(D)
Declan Browne
(D)
Dipesh Kumar Barua
(DK)
Dorota Duklas
(D)
Farhat Mirza
(F)
Fumilola Olaifa
(F)
Harmani Daler
(H)
Hassan Naveed
(H)
Heba Elzeky
(H)
Hedley Emsley
(H)
Honglin Zhu
(H)
Ian Morrison
(I)
Irtiza Syed
(I)
Isabel Summers
(I)
Jack Wellington
(J)
Jasmine Wall
(J)
John O'Dwyer
(J)
Jordan Ford
(J)
Karthikeyan Sivaganesh
(K)
Katja Lassak
(K)
Keara Jamison
(K)
Khalid Hamandi
(K)
Kourosh Parvi
(K)
Lareyna McMenemy
(L)
Lewis McColm
(L)
Lina Aleknaite
(L)
Maithili Srikantha
(M)
Maja Kaladjiska
(M)
Marie Jasim
(M)
Mark McCarron
(M)
Martina Mockova
(M)
Mohammad Marar
(M)
Naghme Adab
(N)
Najma Ahmed
(N)
Nye Rhys Potter
(NR)
Pavithira Tharmapoopathy
(P)
Prithvi Dixit
(P)
Rajiv Mohanraj
(R)
Ravanth Baskaran
(R)
Richard Davenport
(R)
Robert Seah
(R)
Rohan Bhate
(R)
Rohan Gupta
(R)
Sahar Shams
(S)
Siddarth Kannan
(S)
Tahir Majeed
(T)
Timothy Counihan
(T)
Tomas Ferriera
(T)
Yihui Cheng
(Y)
Zaib Shamshi
(Z)
Informations de copyright
Copyright © 2023. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.