Lee Seong Hoon, Gillespie Conor, Bandyopadhyay Soham, Nazari Armin, Ooi Setthasorn Zhi Yang, Park Jay J, Champ Claire, Taylor Claire, Kinney Michael, Mackay Graham, Myint Phyo Kyaw, Marson Anthony
Department of Neurology, Aberdeen Royal Infirmary, NHS Grampian, UK; Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, UK.
Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK; Department of Neurology, The Walton Centre NHS Foundation Trust, UK.
Seizure. 2023 Oct;111:165-171. doi: 10.1016/j.seizure.2023.08.010. Epub 2023 Aug 19.
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.
当前指南为疑似首次发作和癫痫的管理设定了临床标准。我们旨在评估全国范围内的首次发作诊所是否符合这些标准，描述护理差异并确定改善服务提供的机会。
多中心审计评估了自2019年12月31日起转诊至首次发作诊所的成年人（≥16岁）的护理情况（每个中心连续30例患者）。排除已有癫痫诊断的患者。报告了匿名的转诊、诊所和随访数据，并进行了描述性统计。
提供了来自英国和爱尔兰25家医院的727例患者的数据（中位年龄41岁[四分位间距26 - 59]，52%为男性）。中位复查时间为48天（四分位间距26 - 86），13.8%（四分位间距3.3% - 24.0%）的患者在2周内接受了评估。在等待首次预约的患者中，12.7%（四分位间距6.6% - 17.4%）出现了癫痫复发。首次发作/癫痫患者中，85.0%（四分位间距74.0% - 100%）和79.7%（四分位间距71.2% - 96.4%）的患者分别有证人陈述和驾驶建议的记录。在首次预约时，30.1%（四分位间距0% - 42.5%）被诊断为癫痫的患者记录了关于癫痫猝死的讨论。癫痫患者中，MRI神经影像学检查的中位时间为37天[四分位间距22 - 56]，脑电图检查为30天[四分位间距19 - 47]。30.4%（四分位间距0% - 59.5%）的癫痫患者被转诊至癫痫专科护士处。
全国范围内，转诊至首次发作诊所的患者的记录护理存在差异。许多患者在接受癫痫专科医生评估时面临延误，这可能会对后续管理产生影响。
