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

Abstract

ObjectivesAbout 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.Setting154 emergency departments (EDs) across the UK.ParticipantsData 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 measuresDetails 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.ResultsOf 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.ConclusionsThese 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.

An alternative care pathway for suspected seizures in pre-hospital care: a service evaluation

“…Many patients do not receive the specialist follow-up that they need after a seizure in routine care in the NHS (Dixon et al, 2015), and our ACP was able to ensure that these patients received an enhanced level of care. The ACP gave rise to a positive outcome in 55% of cases.…”

“…Precise estimates vary, but in England (population 52.96 million, 42.96 million adults) seizures give rise to approximately 211,000 calls to ambulance services per year (3.3% of all emergency calls) (Dickson et al, 2015). It is estimated that there are 60,000 seizure-related emergency department (ED) attendances per year (2-3% of all attendances) (Dixon, Kirkham, Marson, & Pearson, 2015), and 40,000 hospital admissions which represent 9.5% of all admissions for ACSCs (Dixon et al, 2015;Tian, Dixon, & Gao, 2012). There are currently no published studies of care pathways for people after a suspected seizure (Scottish Ambulance Service, 2007a, 2007b.…”

Cross-sectional study of the hospital management of adult patients with a suspected seizure (EPIC2)

“…Precise estimates vary, but in England (population: 52.96 million, 42.96 million adults), seizures give rise to approximately 211 000 calls to ambulance services per year (3.3% of all emergency calls) 5. It is estimated that there are 60 000 seizure-related Emergency Department (ED) attendances per year (2%–3% of all attendances)6 and 40 000 hospital admissions which represent 9.5% of all admissions for ACSCs 6 7. There are currently no published studies of care pathways for people who have presented as an emergency with a suspected seizure which aim to facilitate urgent medical review8 and avoid unnecessary transport to hospital 9 10.…”

“…However, this opportunity to prevent further seizures and/or to refine the patients’ emergency care plan is often missed 6 8 12 13. Many patients therefore unnecessarily remain at risk of further seizures and the associated morbidity,14 mortality15 and health services costs2 16 of poorly controlled epilepsy.…”

Patient-centred standards of care for adults with myositis

“…As a consequence, we seek to mirror the improvements in practice seen in the management of stroke and epilepsy observed since the commencement of national audit programmes for these conditions [9,10].…”