Care in Europe after presenting to the emergency department with a seizure; position paper and insights from the European Audit of Seizure Management in Hospitals

Background and purpose This position paper makes recommendations following an audit of care provided to people presenting with a seizure to emergency departments (EDs) in Europe. Methods Participating countries were asked to include five hospitals agreeing to identify 50 consecutive seizure patients presenting to their ED between 1 August 2016 and 31 August 2017. Anonymous data were collected to a web database. Where quoted, percentages are mean site values and ranges are the 10th–90th centile. Results Data were collected on 2204 ED visits (47 sites, up to six per country, across 15 countries): 1270 (58%) known epilepsy, 299 (14%) previous blackouts but no epilepsy diagnosis, 634 (29%) with a first seizure. Wide variability was identified for most variables. Of those with known epilepsy, 41.2% (range 26.2%–59.6%) attended the ED in the previous 12 months, but only 64.7% (range 37.2%–79.8%) had seen an epilepsy specialist in the previous 12 months. 67.7% (range 34.0%–100%) were admitted, 53.1% to a neurology ward (range 0.0%–88.9%). Only 37.5% first seizure patients (range 0.0%–71.4%) were given advice about driving. Conclusions and recommendations It is recommended that in Europe guidance is agreed on the management and onward referral of those presenting to the ED with a seizure; a referral process is created that can be easily implemented; it is ensured that the seizure services receive referrals and see the patients within a short time period; and a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care. The European Audit of Seizure Management in Hospitals (EuroNASH) shows that there is considerable and unacceptable variability in the quality of care provided to people presenting to emergency departments with a seizure in Europe. In this position paper it is recommended that in Europe (1) guidance is created and agreed for specialist referral; (2) a process for referral is created that is easy to do and can be incorporated into the workings of local hospitals with minimal effort; (3) it is ensured that the epilepsy/seizure service receives these referrals and sees the patients within a short time period; (4) a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care.