Abstracts

Rationale: The Epilepsy Monitoring Unit (EMU) can be a valuable resource in the diagnosis and treatment of persons with epilepsy. An EMU admission is unique, in that symptoms are induced or allowed to occur by reducing or stopping medications. Due to these factors, the safety and quality of care are particularly important. In the absence of clinical practice guidelines and quality indicators for the EMU, there exists considerable practice variation between EMUs. The purpose of this study is to synthesize all available data on the safety and quality of care in EMUs using a systematic review and meta-analysis.Methods: A systematic review was conducted according to the PRISMA statement. The search strategy used Medline, Embase, PsycInfo, and CINAHL in January 2014 and included broad search terms, and their synonyms, pertaining to quality and safety and the EMU. Two independent reviewers were responsible for screening abstracts, full text, and performing data abstraction (using a standardized data collection form), in duplicate. Data abstracted included: patient demographic variables, EMU demographic variables, admission variables, and quality and safety variables. The quality of included studies was evaluated using the 15-item STROBE checklist for observational studies. Descriptive statistics were used to evaluate all variables and to give an overview of the data reported. A meta-analysis was conducted on variables for which there were ≥ 5 studies that reported estimates (with measures of variance). Publication bias was evaluated visually using a funnel plot and statistically using Begg’s and Egger’s statistics.Results: The search yielded 268 references, of which 55 were reviewed in full text, and an additional 25 were identified through handsearching of full texts. Fifty-six studies were included in the systematic review. The quality and safety data from all of the included studies came from 3121 patients admitted to an EMU between 1968 and 2012. Overall, data were reported on 37 different quality and safety variables. Included studies commonly reported the number of patients (47 studies; median number patients=129), and the clinical population (45 studies). The most common quality and safety data reported were length of stay (26 studies; mean=46 days, SD=1.77), and reason for referral (24 studies). Few studies reported on adverse events (n=16; 29.0%). Meta-analysis was only possible for mean age (34.29; I2=95.21%, p<0.001), mean length of stay (4.07 days; I2=97.93%, p<0.001)), and proportion of adverse events (0.12; I2=98.48%, p<0.001). The mean quality score was 62.6% (9/15; SD = 2.0).Conclusions: This systematic review and meta-analysis found that there is a great deal of heterogeneity in the quality and safety in EMUs and in reporting, and study quality. These findings are the first step in the development of evidence-based, consensus-driven quality indicators for the EMU. These findings also highlight the need for clinical practice guidelines for the EMU to standardize clinical care.