Investigation of first onset seizures in adults in Western Cape Emergency Centres
CITATION: Smith, A.B, Van Hoving, D.J.& Wallis, L.A. 2013. Emergency centre investigation of first-onset seizures in adults in the Western Cape, South Africa. South African Medical Journal, 103(10):723-727, doi:10.7196/SAMJ.6821.
The original publication is available at http://www.samj.org.za/index.php/samj/index
Objectives: This study aimed to review which investigations were done on adults presenting with first onset seizures to six Emergency Centres in the Western Cape Province, South Africa. Methods: A prospective cross-sectional study conducted from 1 July 2011 – 31 December 2011. All adults with first onset seizures were included; children and trauma patients were excluded. Subgroup analysis was conducted regarding HIV status and interfacility variation. Results: Three hundred and nine patients were included. CT scans were planned in 218 (70.6%) patients; 96 (56.8%) had causative abnormalities (infarction, intracerebral haemorrhage and atrophy being the commonest). At least 80% of patients (n=247) received a full renal and electrolyte screen, blood glucose testing and a full haematological screen. Lumbar punctures were done in 67 (21.7%) patients; 51 (76.1%) being normal. Only 27 (8%) patients had an EEG of which 5 (18%) were abnormal. A statistically significant difference exists regarding CT scans (p=0.002) and lumbar punctures (p<0.001) in the HIV positive group (n=49). Conclusion: This study demonstrated inconsistent, unnecessary 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 potentially saving costs.