Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
S Afr Med J. 2013 Aug 21;103(10):723-7. doi: 10.7196/samj.6821.
Patients with first-onset seizures commonly present to emergency centres (ECs). The differential diagnosis is broad, potentially life-threatening conditions need to be excluded, and these patients need to be correctly diagnosed and appropriately referred. There are currently no data on adults presenting with first-onset seizures to ECs in South Africa.
To review which investigations were performed on adults presenting with first-onset seizures to six ECs in the Western Cape Province.
A prospective, cross-sectional study was conducted from 1 July 2011 to 31 December 2011. All adults with first-onset seizures were included; children and trauma patients were excluded. Subgroup analyses were conducted regarding HIV status and inter-facility variation.
A total of 309 patients were included. Computed tomography (CT) scans were planned in 218 (70.6%) patients, but only performed in 169; 96 (56.8%) showed abnormalities judged to be causative (infarction, intracerebral haemorrhage and atrophy being the most common). At least 80% of patients (n=247) received a full renal and electrolyte screen, blood glucose testing and a full haematological screen. Lumbar puncture (LP) was performed in 67 (21.7%) patients, with normal cerebrospinal fluid findings in 51 (76.1%). Only 27 (8%) patients had an electroencephalogram, of which 5 (18%) were abnormal. There was a statistically significant difference in the number of CT scans (p=0.002) and LPs (p<0.001) performed in the HIV-positive group (n=49).
This study demonstrated inconsistency and wide local variance for all types of investigations done. It emphasises the need for a local guideline to direct doctors to appropriate investigations, ensuring better quality patient care and potential cost-saving.
首次发作癫痫的患者通常会到急诊中心（EC）就诊。鉴别诊断范围广泛，需要排除潜在的危及生命的情况，这些患者需要得到正确的诊断和适当的转介。目前，南非尚无关于成人首次发作癫痫到 EC 就诊的相关数据。
回顾在西开普省的 6 家急诊中心就诊的首次发作癫痫的成年人进行了哪些检查。
一项前瞻性、横断面研究于 2011 年 7 月 1 日至 2011 年 12 月 31 日进行。所有首次发作癫痫的成年人均被纳入研究；儿童和创伤患者被排除在外。对 HIV 状态和不同医院之间的差异进行了亚组分析。
共纳入 309 例患者。计划对 218 例（70.6%）患者进行计算机断层扫描（CT）检查，但仅对 169 例进行了检查；96 例（56.8%）显示异常，被认为是病因（梗死、脑内出血和萎缩最为常见）。至少 80%的患者（n=247）接受了完整的肾功能和电解质检查、血糖检测和全血细胞计数检查。对 67 例（21.7%）患者进行了腰椎穿刺（LP）检查，其中 51 例（76.1%）脑脊液正常。仅 27 例（8%）患者进行了脑电图检查，其中 5 例（18%）异常。在 HIV 阳性组（n=49）中，CT 扫描（p=0.002）和 LP 检查（p<0.001）的数量存在统计学差异。
本研究表明，所有类型的检查都存在不一致性和广泛的地域差异。这强调了需要制定当地指南来指导医生进行适当的检查，以确保更好的患者护理质量和潜在的成本节约。
