National Audit of Seizure management in Hospitals (NASH): results of the national audit of adult epilepsy in the UK

Abstract

Objectives: 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.

Setting: 154 emergency departments (EDs) across the UK.

Participants: 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.

Primary and secondary outcome measures: 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.

Results: 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.

Conclusions: 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.

Keywords: ACCIDENT & EMERGENCY MEDICINE; AUDIT; care pathways; seizure.

Figure 1

Comparison of NASH1 and NASH2 data for 101 hospital sites that took part in both audit rounds: mean values of seven key variables (temperature taken in the emergency department; eyewitness statement taken or sought; plantars examined; ECG performed; the patient had some neurological input during their attendance, or was referred to a neurologist as an outpatient; discussion around driving took place with the patient; known epilepsy patients who were sent home on at least one antiepileptic drug).