Emergency centre investigation of first-onset seizures in adults in the Western Cape, South Africa

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dc.contributor.authorSmith, A. B.en_ZA
dc.contributor.authorVan Hoving, D. J.en_ZA
dc.contributor.authorWallis, L. A.en_ZA
dc.date.accessioned2014-07-07T12:32:16Z
dc.date.available2014-07-07T12:32:16Z
dc.date.issued2013-08-21
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractBackground. 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.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/6821
dc.description.versionPublisher's version
dc.format.extent5 pages ; illustrations
dc.identifier.citationSmith, 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.
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.6821
dc.identifier.urihttp://hdl.handle.net/10019.1/94556
dc.language.isoen
dc.publisherHealth & Medical Publishing Group
dc.rights.holderAuthors retain copyright
dc.subjectTrauma centersen_ZA
dc.subjectEmergency medicineen_ZA
dc.subjectAdult onset seizuresen_ZA
dc.subjectNeurologyen_ZA
dc.subjectEpilepsyen_ZA
dc.subjectTomographyen_ZA
dc.subjectMagnetic resonance imaging
dc.titleEmergency centre investigation of first-onset seizures in adults in the Western Cape, South Africaen_ZA
dc.typeArticle
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