Dixon Peter A, Kirkham Jamie J, Marson Anthony G, Pearson Mike G
Department of Molecular and Clinical Pharmacology, University of Liverpool, Clinical Sciences Centre, Liverpool, UK.
Department of Biostatistics, University of Liverpool, Liverpool, UK.
BMJ Open. 2015 Mar 31;5(3):e007325. doi: 10.1136/bmjopen-2014-007325.
About 100,000 people present to hospitals each year in England with an epileptic seizure. How they are managed is unknown; thus, the National Audit of Seizure management in Hospitals (NASH) set out to assess prior care, management of the acute event and follow-up of these patients. This paper describes the data from the second audit conducted in 2013.
154 emergency departments (EDs) across the UK.
Data from 4544 attendances (median age of 45 years, 57% men) showed that 61% had a prior diagnosis of epilepsy, 12% other neurological problems and 22% were first seizure cases. Each ED identified 30 consecutive adult cases presenting due to a seizure.
Details were recorded of the patient's prior care, management at hospital and onward referral to neurological specialists onto an online database. Descriptive results are reported at national level.
Of those with epilepsy, 498 (18%) were on no antiepileptic drug therapy and 1330 (48%) were on monotherapy. Assessments were often incomplete and witness histories were sought in only 759 (75%) of first seizure patients, 58% were seen by a senior doctor and 57% were admitted. For first seizure patients, advice on further seizure management was given to 264 (27%) and only 55% were referred to a neurologist or epilepsy specialist. For each variable, there was wide variability among sites that was not explicable. For the sites who partook in both audits, there was a trend towards better care in 2013, but this was small and dwarfed by the intersite variability.
These results have parallels with the Sentinel Audit of Stroke performed a decade earlier. There is wide intersite variability in care covering the entire care pathway, and a need for better organised and accessible care for these patients.
在英国，每年约有10万人因癫痫发作前往医院就诊。目前尚不清楚他们的治疗情况；因此，医院癫痫发作管理全国审计（NASH）旨在评估这些患者的前期护理、急性发作的管理及后续随访情况。本文介绍了2013年进行的第二次审计的数据。
英国各地的154个急诊科。
4544例就诊患者的数据（中位年龄45岁，57%为男性）显示，61%的患者先前被诊断为癫痫，12%有其他神经系统问题，22%为首次发作病例。每个急诊科连续确定30例因癫痫发作就诊的成年病例。
将患者的前期护理、在医院的治疗情况以及后续转介至神经科专家的详细信息记录在一个在线数据库中。在国家层面报告描述性结果。
在癫痫患者中，498例（18%）未接受抗癫痫药物治疗，1330例（48%）接受单一疗法治疗。评估往往不完整，仅759例（75%）首次发作患者进行了目击者病史询问，58%的患者由 senior doctor 诊治，57%的患者住院。对于首次发作患者，264例（27%）得到了关于进一步癫痫发作管理的建议，仅55%的患者被转介至神经科医生或癫痫专家处。对于每个变量，各机构之间存在很大差异，无法解释。对于参与两次审计的机构，2013年有护理改善的趋势，但幅度很小，且与机构间差异相比微不足道。
这些结果与十年前进行的中风哨兵审计结果相似。在整个护理过程中，各机构之间的护理差异很大，需要为这些患者提供更有组织、更易获得的护理。
