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. 2022 Jul;29(7):1873-1884.
doi: 10.1111/ene.15336. Epub 2022 May 7.

Care in Europe after presenting to the emergency department with a seizure; position paper and insights from the European Audit of Seizure Management in Hospitals

Claire Taylor  1 , Catrin Tudur-Smith  1 , Pete Dixon  1 , Christine Linehan  2 , Aleksei Gunko  2 , Jakob Christensen  3   4 , Mike Pearson  1 , Torbjorn Tomson  5 , Anthony Marson  5   6 ; ESBACE consortium and EuroNASH collaborators
Collaborators, Affiliations

Care in Europe after presenting to the emergency department with a seizure; position paper and insights from the European Audit of Seizure Management in Hospitals

Claire Taylor et al. Eur J Neurol. 2022 Jul.

Abstract

Background and purpose: This position paper makes recommendations following an audit of care provided to people presenting with a seizure to emergency departments (EDs) in Europe.

Methods: Participating countries were asked to include five hospitals agreeing to identify 50 consecutive seizure patients presenting to their ED between 1 August 2016 and 31 August 2017. Anonymous data were collected to a web database. Where quoted, percentages are mean site values and ranges are the 10th-90th centile.

Results: Data were collected on 2204 ED visits (47 sites, up to six per country, across 15 countries): 1270 (58%) known epilepsy, 299 (14%) previous blackouts but no epilepsy diagnosis, 634 (29%) with a first seizure. Wide variability was identified for most variables. Of those with known epilepsy, 41.2% (range 26.2%-59.6%) attended the ED in the previous 12 months, but only 64.7% (range 37.2%-79.8%) had seen an epilepsy specialist in the previous 12 months. 67.7% (range 34.0%-100%) were admitted, 53.1% to a neurology ward (range 0.0%-88.9%). Only 37.5% first seizure patients (range 0.0%-71.4%) were given advice about driving.

Conclusions and recommendations: It is recommended that in Europe guidance is agreed on the management and onward referral of those presenting to the ED with a seizure; a referral process is created that can be easily implemented; it is ensured that the seizure services receive referrals and see the patients within a short time period; and a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care.

Keywords: audit; epilepsy; neurological disorders; quality improvement; service evaluation.

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Conflict of interest statement

Claire Taylor, Pete Dixon, Mike Pearson, Catrin Tudur Smith, Christine Linehan and Alex Gunko have no conflicts of interest to declare. Professor Marson leads the UK Audit of Seizure Management in Hospitals, which is supported by a grant from UCB Pharma to the University of Liverpool. Dr Christensen has received honoraria for serving on the Scientific Advisory Board of Union Chimique Belge (UCB) Nordic and Eisai AB. Dr Christensen has also received honoraria for giving lectures for UCB Nordic and Eisai and received travel funds from UCB Nordic. Dr Tomson reports speakers’ honoraria to his institution from Eisai, Sanofi, Sun Pharmaceutical Industries Ltd and UCB, and research support from Bial, Eisai, GlaxoSmithKline, Stockholm County Council, Teva, GW Pharma, Arvelle and UCB.

Figures

FIGURE 1
FIGURE 1
Variation between sites in undertaking investigations for group 3 (likely first seizure patients). Box and whisker plot showing median of site means, 25th and 75th centiles and range [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Variation in the seeking of a witness description in first seizure presentations (group 3) across countries—the seven countries with one site each appear as ‘other’
FIGURE 3
FIGURE 3
Variation by country and site as to whether a CT scan was ordered after a seizure presentation in group 1 patients
FIGURE 4
FIGURE 4
Variation by country and site of proportions referred for a specialist opinion (group 1)
See this image and copyright information in PMC

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