Emergency centre investigation of first-onset seizures in adults in the Western Cape, South Africa
Background. Patients with first-onset seizures commonly present to emergency centres (ECs). The differential diagnosis is broad, potentially life-threatening conditions need to be excluded, and these patients need to be correctly diagnosed and appropriately referred. There are currently no data on adults presenting with first-onset seizures to ECs in South Africa.
Objective. To review which investigations were performed on adults presenting with first-onset seizures to six ECs in the Western Cape Province.
Methods. A prospective, cross-sectional study was conducted from 1 July 2011 to 31 December 2011. All adults with first-onset seizures were included; children and trauma patients were excluded. Subgroup analyses were conducted regarding HIV status and inter-facility variation.
Results. A total of 309 patients were included. Computed tomography (CT) scans were planned in 218 (70.6%) patients, but only performed in 169; 96 (56.8%) showed abnormalities judged to be causative (infarction, intracerebral haemorrhage and atrophy being the most common). At least 80% of patients (n=247) received a full renal and electrolyte screen, blood glucose testing and a full haematological screen. Lumbar puncture (LP) was performed in 67 (21.7%) patients, with normal cerebrospinal fluid findings in 51 (76.1%). Only 27 (8%) patients had an electroencephalogram, of which 5 (18%) were abnormal. There was a statistically significant difference in the number of CT scans (p=0.002) and LPs (p<0.001) performed in the HIV-positive group (n=49).
Conclusion. This study demonstrated inconsistency and wide local variance for all types of investigations done. It emphasises the need for a local guideline to direct doctors to appropriate investigations, ensuring better quality patient care and potential cost-saving.
Anne Beth Smith, Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Daniël Jacobus van Hoving, Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Lee Allan Wallis, Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Date published: 2013-08-21
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