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).


CONCLUSIONS
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.
Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. annebsmith@gmail.com.
A B
AB
Smith
D J
DJ
Van Hoving
L A
LA
Wallis
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis*; D013019:South Africa / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult