Williams Jennifer, Doherty Jack, Di Blasi Chiara, Mabarak Dimitri, Kennedy Una, Doherty Colin P
Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland; The Academic Unit of Neurology, Trinity Biomedical Science Institute, 152-160 Pearse Street, Dublin 2, Ireland.
Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland.
Epilepsy Behav. 2018 Jan;78:226-231. doi: 10.1016/j.yebeh.2017.08.042. Epub 2017 Nov 10.
Care for seizures in an emergency department setting can be variable, and there are disparities in access to onward specialist referral. The purpose of this study was to evaluate the utilization and implementation of an evidence-based seizure care pathway in a busy urban tertiary referral center. A total of 644 seizure presentations over two time points were examined. Initial pathway utilization rates were low at 26.2% but increased to 61.6% after environmental barriers had been addressed. We found that patients placed on the care pathway had higher rates of neurological examination, documentation of safety and legal guidelines as regards driving, and lower rates of seizure readmission. Twelve patients not placed on the pathway had passed away at follow-up (1.86%); the cause of death were related to significant comorbidities rather than the seizures themselves though in five, seizures could potentially have been a contributing factor. For the first time we have demonstrated that an evidence-based guideline for seizure management can be implemented in Ireland and used to standardize care for seizures in the emergency department improving documentation rates and clinical evaluation.
在急诊科处理癫痫发作的方式可能各不相同，在获得后续专科转诊方面也存在差异。本研究的目的是评估在一家繁忙的城市三级转诊中心实施循证癫痫护理路径的情况及应用效果。共对两个时间点的644例癫痫就诊病例进行了检查。最初护理路径的使用率较低，仅为26.2%，但在解决了环境障碍后，使用率提高到了61.6%。我们发现，纳入护理路径的患者进行神经学检查的比例更高，记录了关于驾驶的安全和法律指南，癫痫再入院率更低。12例未纳入护理路径的患者在随访时死亡（1.86%）；死亡原因与严重的合并症有关，而非癫痫本身，不过在5例患者中，癫痫可能是一个促成因素。我们首次证明，循证癫痫管理指南可以在爱尔兰实施，并用于规范急诊科癫痫护理，提高记录率和临床评估水平。
