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Management of febrile convulsion: scene in a regional hospital
1Department of Paediatrics, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong, ROC. maksk@ha.org.hk
Insights
This study found that many children with febrile convulsions received unnecessary tests, leading to high costs and little diagnostic value. Guidelines for managing febrile convulsions should be followed more closely.
Area of Science:
- Pediatric Neurology
- Clinical Practice Audit
Background:
- Febrile convulsions are common in children.
- Adherence to practice parameters in managing febrile convulsions is crucial for optimal patient care and resource utilization.
Purpose of the Study:
- To evaluate the adherence to established practice parameters in the management of pediatric febrile convulsions.
- To assess the appropriateness of investigations and treatments in children presenting with febrile convulsions.
Main Methods:
- A retrospective study was conducted on 94 patient records from a Hong Kong public hospital.
- Practice parameters from the American Academy of Pediatrics and audit measures were used as standards.
- Data on documentation, investigations, and treatment were analyzed.
Main Results:
- Accurate seizure description was documented in 92% of cases, but meningitis signs and parental counseling were documented less frequently (64% and 85%).
- A mean of seven routine investigations were performed per patient, with electroencephalography (11%) and CT scans (2%) being inappropriately used.
- No delays in diagnosing central nervous system infections occurred, and all patients were discharged with symptomatic treatment.
Conclusions:
- The study identified a high rate of unnecessary investigations in managing febrile convulsions, indicating a need for improved adherence to clinical guidelines.
- Investigations often provided little diagnostic value and incurred significant costs.
- Diagnostic procedures should be reserved for cases where indicated by clinical presentation or medical history.
Objective:
To determine whether practice parameters are applied to the management of children with febrile convulsion.
Design:
Retrospective study.
Setting:
Paediatric department of a public hospital, Hong Kong.
Methods:
Practice parameters of the American Academy of Pediatrics and audit measures recommended by the Joint Working Group of the Research Unit of the Royal College of Physicians and the British Paediatric Association were employed as standards. Records between January and April 2000 with the diagnostic coding of febrile convulsion, convulsion, status epilepticus, or meningitis/encephalitis/encephalopathy were reviewed. Areas assessed were appropriate documentation of hospital records and unit statistics (adverse outcomes, inappropriate investigations and treatment).
Results:
Ninety-four consecutive records were evaluated. In the documentation of hospital notes, accurate description of seizure was observed in 92%, incorrect diagnosis or coding in 12%, and presence/absence of signs of meningitis and parental counselling documented in 64% and 85%, respectively. Regarding unit statistics, investigations performed included a complete blood count, blood glucose, serum calcium, serum electrolytes, renal function tests, liver function tests, chest X-ray, and urinalysis. The mean number of routine investigations was seven. The average length of stay was 2 days. There were no cases of delay in the diagnosis of central nervous system infection. Inappropriate investigations and treatment were as follows: electroencephalography 11%, computed tomography brain scan 2%, and maintenance anticonvulsants 2%. All patients were discharged home with panadol regardless of clinical state.
Conclusions:
The present study showed that the use of unnecessary investigations was common. Investigations, though resulting in significant expense, proved to be of little diagnostic value. Diagnostic procedures should be performed only when specifically called for by the patient's condition or medical history.
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