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An audit of first afebrile seizure management in an Irish tertiary pediatric setting
Michael Boyle1, Joseph Chukwu, Mary Boyle
1Department of Paediatric Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland, mijkboyle@yahoo.com.
Insights
Management of first afebrile seizures in Ireland initially lacked compliance with international standards. Improvements were seen after implementing specific guidelines and education, enhancing patient care for this common pediatric presentation.
Area of Science:
- Pediatric Neurology
- Clinical Quality Improvement
- Evidence-Based Medicine
Background:
- First afebrile seizures are a common presentation in pediatric emergency departments.
- International guidelines exist for managing first afebrile seizures, but adherence may vary.
- Tertiary pediatric centers require robust protocols for optimal patient outcomes.
Purpose of the Study:
- To compare the management of first afebrile seizures against international standards in an Irish tertiary pediatric setting.
- To identify areas of non-compliance and implement improvements.
- To assess the impact of revised standards and educational interventions on seizure management.
Main Methods:
- Development of 21 management standards based on NICE (2004) and AAN (2003) guidelines.
- Retrospective audit of first afebrile seizure cases (July 2007-June 2010).
- Implementation of standards, parental advice sheets, and stakeholder engagement, followed by a re-audit (July 2010-June 2011).
Main Results:
- No cases achieved full compliance in the initial audit (A1).
- Median compliance scores improved significantly from 15 in A1 to 17 in A2 (p < 0.0001).
- Optimal compliance (≥17) increased from 6/40 patients in A1 to 21/41 in A2 (p = 0.001).
Conclusions:
- Initial management of first afebrile seizures in the studied setting did not align with international guidelines.
- Implementing defined standards and critical appraisal through education significantly improved compliance.
- This approach can enhance the quality of care for first afebrile seizures.
Unlabelled:
The objective of this study was to compare the first afebrile seizure management with internationally recognized standards in an Irish tertiary pediatric setting. Twenty-one management standards were derived from a combination of British (NICE 2004) and North American (AAN 2003) guidelines. Cases of first afebrile seizure presenting to a pediatric emergency department between July 2007 and June 2010 were assessed against the standards. On completion, the standards developed were presented to the relevant stakeholders, a nurse-developed parental advice sheet was introduced, and a re-audit was performed from July 2010 to June 2011. Forty children were identified in the initial audit period (A1) and 41 over the re-audit (A2). No case achieved full compliance with the devised standards in the audit period. A median compliance score of 15 (range 5-20) was achieved in A1 and 17 (range 11-21) in A2 [mean rank 31.93 versus 49.85; p(1,1) < 0.0001]. Optimal compliance (total score of ≥17) with devised standards was achieved in 6/40 patients in A1 and in 21/41 patients in A2 [χ (2) = 11.95; p(1,1) = 0.001].
Conclusion:
We demonstrated an initial lack of compliance with international guidelines on management of a common medical presentation, first afebrile seizure, and demonstrated that improvements can be achieved by identification of appropriate standards and critical appraisal of the compliance with these standards through both formal and informal education.
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