Rizvi Syed, Hernandez-Ronquillo Lizbeth, Moien-Afshari Farzad, Hunter Gary, Waterhouse Karen, Dash Dianne, Téllez-Zenteno José F
Saskatchewan Epilepsy Program, Division of Neurology, University of Saskatchewan, Canada.
Saskatchewan Epilepsy Program, Division of Neurology, University of Saskatchewan, Canada.
J Neurol Sci. 2016 Aug 15;367:203-10. doi: 10.1016/j.jns.2016.05.060. Epub 2016 Jun 6.
The effect of the single seizure clinic (SSC) model on patient diagnose, work-up, wait-times, and clinical care is poorly characterized and its efficacy unclear. The present study assesses patient characteristics and evaluates the impact of a single seizure clinic (SSC) model on wait-times and access to care.
A prospective study of all patients (n=200) referred to our SSC for first seizure evaluation. Demographic, clinical, and paraclinicial variables were systematically collected and analyzed against a historical cohort. Binary logistic regression analysis was performed to predict impact of dichotomized variables on diagnosis of epilepsy. Diagnostic concordance between SSC nurses and epileptologists was also assessed.
Predominant referral sources were emergency department physicians and general practitioners. Mean wait-time for first assessment was significantly reduced by 70.5% employing the SSC model versus historical usual care. A diagnosis was established at first-contact in 80.5% of cases while 16.0% of patients required a second visit. Eighty-two patients (41.0%) were diagnosed with epilepsy. An abnormal EEG was found in 93.9% of patients diagnosed with epilepsy. Sixty-three patients were started on anti-epileptic drugs (63.5% lamotrigine, 7.0% levetiracetam, 5.0% phenytoin, and 5.0% topiramate). In 18% of cases driving restrictions were initiated by the SSC. The most common non-seizure diagnosis was syncope (24.0%).
The SSC reduced wait-times for assessment and investigations, clarified diagnoses, affected management decisions with respect to further workup, pharmacotherapy, and driving. There was moderate correlation between SSC nurses and physicians (kappa=0.54; p<0.001) as physicians were significantly more likely to diagnose epilepsy. Key factors identified as predictors of epilepsy were: presence of abnormalities on electroencephalography and imaging studies, patients stratified as high or medium-risk for seizure recurrence, semiological characteristics such as amnesia and limb stiffening, and presence of tongue trauma, or incontinence.
The SSC model reduces wait-times, streamlines assessments, and impacts clinical care decisions.
单次发作门诊（SSC）模式对患者诊断、检查、等待时间及临床护理的影响鲜为人知，其疗效也不明确。本研究评估了患者特征，并评价了单次发作门诊（SSC）模式对等待时间及获得医疗服务的影响。
对所有转诊至我院单次发作门诊（SSC）进行首次发作评估的患者（n = 200）进行前瞻性研究。系统收集人口统计学、临床及辅助检查变量，并与历史队列进行分析比较。采用二元逻辑回归分析预测二分变量对癫痫诊断的影响。同时评估了SSC护士与癫痫专家之间的诊断一致性。
主要转诊来源为急诊科医生和全科医生。与历史常规护理相比，采用SSC模式后首次评估的平均等待时间显著缩短了70.5%。80.5%的病例在首次就诊时确诊，16.0%的患者需要再次就诊。82例患者（41.0%）被诊断为癫痫。93.9%诊断为癫痫的患者脑电图异常。63例患者开始使用抗癫痫药物（63.5%为拉莫三嗪，7.0%为左乙拉西坦，5.0%为苯妥英，5.0%为托吡酯）。在18%的病例中，SSC启动了驾驶限制。最常见的非发作性诊断为晕厥（24.0%）。
SSC缩短了评估和检查的等待时间，明确了诊断，影响了进一步检查、药物治疗及驾驶等方面的管理决策。SSC护士与医生之间存在中度相关性（kappa = 0.54；p < 0.001），因为医生诊断癫痫的可能性显著更高。被确定为癫痫预测因素的关键因素包括：脑电图和影像学检查异常、被分层为癫痫复发高风险或中风险的患者、失忆和肢体僵硬等症状学特征以及舌部创伤或大小便失禁的存在。
SSC模式缩短了等待时间，简化了评估，并影响了临床护理决策。
