Abstracts

Prior to developing a local population based combined and integrated service for children with epilepsy in the Mid-Trent Region, UK, a baseline audit of current services was undertaken.
For the first phase, consultant paediatricians seeing children referred to two hospitals in Nottingham City (population [raquo] 600, 000) with suspected epilepsy were asked to collaborate with a systematic clinical audit of first clinic attendance with suspected epilepsy from January 2001- March 2002. Children were ascertained by systematically searching copy clinical letters from all consultant firms; on computer or hard copies, for key words [ldquo]epilepsy[rdquo], [ldquo]fit[rdquo], [ldquo]seizure[rdquo] and [ldquo]convulsion[rdquo]. The BPNA (British Paediatric Neurology Association) audit tool was used to assess various aspects of the assessment. In the second phase Nottingham children referred to community paediatricians during the same time period is being ascertained and complete data will be available soon.
All consultants agreed to participate. 76 children were seen by general paediatricans, 11 were seen by paediatric neurologists. Data obtained to date is presented and corresponds to both hospitals but not yet the community. Results from the previous BPNA audit are included for comparison.
The history was well recorded (mean 85% vs. 90%). 18% were given a diagnosis of epilepsy, 28% non-epileptic and 54% uncertain. Paediatricians appeared unlikely to make a diagnosis of epilepsy at the first clinic attendance. No child diagnosed with epilepsy received a diagnosis of an epilepsy syndrome or category as listed. Documentation of development and school performance was not good (55% vs. 75%). Documentation of physical and neurological examination was good (92% vs. 96%).
All those diagnosed with epilepsy had EEGs performed or requested and 31% had CT or MRI requested. Of those in whom the diagnosis was uncertain an EEG was performed in 89%. In those in whom the diagnosis was not epilepsy an EEG was performed in 38%. Drug treatment and doses and follow-up plans were recorded in all where applicable. Documentation describing referral to an epilepsy nurse or support group was rarely made (13% vs. 24%).
A revision of the BPNA audit tool has been proposed to the BPNA audit group. An integrated care pathway for children with epilepsy in the Mid-Trent Region is currently being discussed which will propose alternative models of care for children with epilepsy. A revised data collection proforma is being piloted which aims to provide a more comprehensive record of clinical data, diagnostic formulation and subsequent management.
In the context of growing concern in the UK regarding the care of children and adults with a diagnosis of epilepsy, audits such as this are important tools in examining and informing local practice as well as contributing to a wider debate on epilepsy service provision.