title: An audit of first afebrile seizure management in an Irish tertiary pediatric setting.
abstract: The objective of this study was to compare the first afebrile seizure management with internationally recognized standards in an Irish tertiary pediatric setting. Twenty-one management standards were derived from a combination of British (NICE 2004) and North American (AAN 2003) guidelines. Cases of first afebrile seizure presenting to a pediatric emergency department between July 2007 and June 2010 were assessed against the standards. On completion, the standards developed were presented to the relevant stakeholders, a nurse-developed parental advice sheet was introduced, and a re-audit was performed from July 2010 to June 2011. Forty children were identified in the initial audit period (A1) and 41 over the re-audit (A2). No case achieved full compliance with the devised standards in the audit period. A median compliance score of 15 (range 5-20) was achieved in A1 and 17 (range 11-21) in A2 [mean rank 31.93 versus 49.85; p(1,1) < 0.0001]. Optimal compliance (total score of ≥17) with devised standards was achieved in 6/40 patients in A1 and in 21/41 patients in A2 [χ (2) = 11.95; p(1,1) = 0.001].
  
  
  CONCLUSIONS
  We demonstrated an initial lack of compliance with international guidelines on management of a common medical presentation, first afebrile seizure, and demonstrated that improvements can be achieved by identification of appropriate standards and critical appraisal of the compliance with these standards through both formal and informal education.
authors.affiliation: Department of Paediatric Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland, mijkboyle@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Boyle
authors.forename: Joseph
authors.initials: J
authors.lastname: Chukwu
authors.forename: Mary
authors.initials: M
authors.lastname: Boyle
authors.forename: Ann
authors.initials: A
authors.lastname: Connolly
authors.forename: David
authors.initials: D
authors.lastname: Webb
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007494:Ireland; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards; D012640:Seizures / Q000628:therapy*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*