Management of children presenting with suspected febrile seizures to the emergency department : analysis of practices at a national acute hospital

Abstract

BACKGROUND: This audit aimed to assess adherence to best practices in the management of febrile seizures in children at Mater Dei Hospital's Paediatric Emergency Department, Malta's national acute teaching hospital.

METHODS: A retrospective review of 54 patient charts diagnosed with febrile seizures in the Paediatric Emergency Department over a 3-month period was conducted. Data collected included demographics, seizure details, medical history, family history, physical examination findings, investigations performed, discharge education provided, and follow-up practices.

RESULTS: A review of seizure documentation revealed inconsistencies in data capture. While core demographic information and seizure descriptions were consistently recorded, crucial details necessary for accurate seizure classification were discrepant. These discrepancies included information pertaining to past medical and family history, as well as thorough documentation of potential seizure risk factors. Physical examinations often demonstrated an incomplete picture, lacking a comprehensive neurological assessment. Furthermore, utilization of diagnostic investigations exceeded recommended international protocols for uncomplicated cases. Additionally, significant variability was observed in both discharge education practices and follow-up appointment scheduling. Inconsistencies in medical record terminology, potentially stemming from non-standardized clerking, may have contributed to underreporting of certain seizure details.

CONCLUSION: These findings suggest a need for improvement in managing febrile seizures in the Paediatric Emergency Department. Implementing standardized documentation based on the National Institute for Health and Care Excellence's Clinical Knowledge Summaries guidelines and developing a comprehensive febrile seizure information leaflet for parents are recommended. This would promote consistent, high-quality care, reduce parental anxiety, and enhance adherence to best practices for febrile seizure management.