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Diagnosis of first paroxysmal events at the children’s ER at a Swedish Regional hospital – including a one year follow up

Stålhammar, Karin LU (2012) LÄKM01 20121
MD Programme
Abstract (Swedish)
Diagnosis of first paroxysmal events at the children’s ER at a Swedish Regional hospital – including a one year follow up

Background
First epileptic seizures can be difficult to diagnose properly as there are many differential diagnoses including provoked seizures, febrile seizures, syncope, breath holding spells and psychogenic seizures. Many articles highlight the importance of a diligent medical history taking, focusing on child characteristics, precipitating factors and event semiology to differ between diagnoses, while imaging studies, and locally also EEG, are considered to have less central roles.
Aim
We aimed to benchmark current practices at the children’s ER in Lund in diagnosing paroxysmal events and also to follow the... (More)
Diagnosis of first paroxysmal events at the children’s ER at a Swedish Regional hospital – including a one year follow up

Background
First epileptic seizures can be difficult to diagnose properly as there are many differential diagnoses including provoked seizures, febrile seizures, syncope, breath holding spells and psychogenic seizures. Many articles highlight the importance of a diligent medical history taking, focusing on child characteristics, precipitating factors and event semiology to differ between diagnoses, while imaging studies, and locally also EEG, are considered to have less central roles.
Aim
We aimed to benchmark current practices at the children’s ER in Lund in diagnosing paroxysmal events and also to follow the management and eventual revisions of diagnosis during one year from index event.
Methods
Charts of children who have sought care 2010, visits specified by International Classification of disease ICD codes compatible with paroxysmal events were reviewed and those who were seen at the ER because of their first paroxysmal event were included in our cohort.
Results
161 children were seen at ER for their first paroxysmal event at the children’s ER in Lund 2010. The initial diagnoses were: epilepsy (n=5), unspecified seizures (n=31), other (n=8), febrile seizures (n=59), provoked seizures (n=3), and syncope (n=55).
We found that there was a considerable amount of potentially important information not documented in the medical charts. Also neurological examinations were often not, or insufficiently, recorded. On the other hand, EEGs were performed in situations not indicated by the local pro memoriam.
Roughly one third of children were seen again (n=54). The final diagnoses were epilepsy (n=17), unspecified seizures (n=10), other (n=5), febrile seizures (n=17), provoked seizures (n=1), and syncope (n=4).
Conclusions
We found that important information is often lacking in medical charts, that clinical neurological examination is often insufficiently recorded, while generally more investigations than recommended were performed. This implies the need of a bedside aid for doctors to guide and remind them of important aspects of history-taking and clinical examination. (Less)
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author
Stålhammar, Karin LU
supervisor
organization
course
LÄKM01 20121
year
type
H2 - Master's Degree (Two Years)
subject
keywords
first seizure, ER
language
English
id
2628571
date added to LUP
2012-09-13 12:08:06
date last changed
2012-09-13 12:08:06
@misc{2628571,
  abstract     = {Diagnosis of first paroxysmal events at the children’s ER at a Swedish Regional hospital – including a one year follow up 

Background
First epileptic seizures can be difficult to diagnose properly as there are many differential diagnoses including provoked seizures, febrile seizures, syncope, breath holding spells and psychogenic seizures. Many articles highlight the importance of a diligent medical history taking, focusing on child characteristics, precipitating factors and event semiology to differ between diagnoses, while imaging studies, and locally also EEG, are considered to have less central roles. 
Aim
We aimed to benchmark current practices at the children’s ER in Lund in diagnosing paroxysmal events and also to follow the management and eventual revisions of diagnosis during one year from index event.
Methods
Charts of children who have sought care 2010, visits specified by International Classification of disease ICD codes compatible with paroxysmal events were reviewed and those who were seen at the ER because of their first paroxysmal event were included in our cohort. 
Results
161 children were seen at ER for their first paroxysmal event at the children’s ER in Lund 2010. The initial diagnoses were: epilepsy (n=5), unspecified seizures (n=31), other (n=8), febrile seizures (n=59), provoked seizures (n=3), and syncope (n=55).
We found that there was a considerable amount of potentially important information not documented in the medical charts. Also neurological examinations were often not, or insufficiently, recorded. On the other hand, EEGs were performed in situations not indicated by the local pro memoriam.
Roughly one third of children were seen again (n=54). The final diagnoses were epilepsy (n=17), unspecified seizures (n=10), other (n=5), febrile seizures (n=17), provoked seizures (n=1), and syncope (n=4).
Conclusions
We found that important information is often lacking in medical charts, that clinical neurological examination is often insufficiently recorded, while generally more investigations than recommended were performed. This implies the need of a bedside aid for doctors to guide and remind them of important aspects of history-taking and clinical examination.},
  author       = {Stålhammar, Karin},
  keyword      = {first seizure,ER},
  language     = {eng},
  note         = {Student Paper},
  title        = {Diagnosis of first paroxysmal events at the children’s ER at a Swedish Regional hospital – including a one year follow up},
  year         = {2012},
}