Related Experiment Video
Updated: Jun 16, 2026
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
A nurse-led 'first fitter' clinic in a paediatric emergency department: an experience
Kim Williams1, Richard Appleton, Briar Stewart
1Department of Accident and Emergency, Alder Children's NHS Trust, Liverpool, UK.
Insights
A new clinic for children experiencing a first epileptic seizure improved follow-up care and addressed parental concerns. The study found about one-third of children were misdiagnosed, highlighting the need for accurate diagnosis of epileptic seizures.
Area of Science:
- Pediatrics
- Neurology
- Emergency Medicine
Background:
- Children presenting with 'jerking' or loss of consciousness may have various conditions, including epileptic seizures, vasovagal events, or cardiac syncope.
- Lack of standardized follow-up for first-time epileptic tonic-clonic seizures causes parental anxiety.
- A First Fitter Clinic (FFC) was established to standardize management for these children.
Purpose of the Study:
- To evaluate the effectiveness and attendance of a newly established First Fitter Clinic (FFC) for children with suspected first epileptic tonic-clonic seizures.
- To standardize the follow-up process and provide parental support and advice regarding recurrent events.
Main Methods:
- Children diagnosed with a first tonic-clonic epileptic seizure in the A&E department were offered an FFC appointment within 3 weeks.
- The clinic was managed by an advanced nurse practitioner.
- Standardized proformas were used to record seizure details and gather information on other paroxysmal events.
Main Results:
- 117 out of 120 (97%) children attended the FFC.
- 82% of attendees were confirmed to have had an epileptic tonic-clonic seizure.
- Approximately one-third of children were misdiagnosed, with other conditions like vasovagal attacks being identified.
Conclusions:
- The FFC demonstrated high attendance, indicating family appreciation for early follow-up and support.
- The clinic effectively addressed parental concerns and provided guidance on managing seizure recurrence.
- The study highlighted a significant rate of misdiagnosis for first-time tonic-clonic seizures in children.
Background:
The diagnoses of a child who presents to an Accident and Emergency (A&E) department with 'jerking' or loss of consciousness include an epileptic seizure, vasovagal event, cardiac syncope or other paroxysmal event. Where the likely diagnosis is a first epileptic tonic-clonic seizure, there is no consensus on how these children should be followed-up. This is important as many parents of children who experience an epileptic tonic-clonic seizure will be anxious and concerned about a recurrence and what to do if it does. A first fitter clinic (FFC) was established in the Accident and Emergency Department of our hospital to standardise the management of these children.
Methods:
Children presenting to the A&E department of a large children's hospital considered to have had a first tonic-clonic epileptic seizure were offered an appointment for the FFC within 3 weeks of their attendance. The clinic was supervised by an advanced nurse practitioner. Details of the child's reported tonic-clonic seizure were recorded on to a standardised proforma and additional information was obtained on other paroxysmal epileptic and non-epileptic events.
Results:
Altogether, 120 children were offered an appointment in the FFC, of which 117 (97%) attended. Their mean age was 9.5 (range: 3.5-15.2)years. Following review in the clinic, 82 (70.1%) of the 117 children were considered to have experienced an epileptic tonic-clonic seizure. Twenty-eight patients were considered to have had a vaso-vagal attack or reflex anoxic seizure; two, a possible cardiac arrhythmia; two a breath-holding episode and in three patients the events could not be classified.
Conclusion:
The FFC was well-attended suggesting that families appreciated early follow-up and the opportunity to address their concerns and provide advice about what to do if there was a recurrence. The study also demonstrated that approximately one-third of children were misdiagnosed as having experienced a tonic-clonic seizure.
Related Concept Videos
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:22The Professional Nurse
Communication skills: These are critical characteristics, especially speaking and listening.
01:20Acute Kidney Injury V: Interprofessional Care
00:59Hospitals-II
Nurses that work in hospitals have...
01:17Ethical Dilemmas I
Let us explore some examples to understand the potentially complex moral decisions nurses face.
Take the case of caring for minors, particularly in areas related to reproductive...
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution itself.