Friday, August 28, 2015

Seizure action plans (surprise)

Roundy LM, Filloux FM, Kerr L, Rimer A, Bonkowsky JL. Seizure Action Plans Do
Not Reduce Health Care Utilization in Pediatric Epilepsy Patients. J Child
Neurol. 2015 Aug 5. pii: 0883073815597755. [Epub ahead of print]


Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce health care utilization and improve outcomes. The authors conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a "Seizure Action Plan." The authors evaluated for differences in health care utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. The authors found that there was no decrease in these measures of health care utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 vs 3.3, P = .006). However, the study was underpowered to detect smaller differences. This study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce health care utilization and improve outcomes.

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1 comment:

  1. Hartman AL, Devore CD; and the SECTION ON NEUROLOGY, COUNCIL ON SCHOOL HEALTH;and the SECTION ON NEUROLOGY COUNCIL ON SCHOOL HEALTH. Rescue Medicine for Epilepsy in Education Settings. Pediatrics. 2015 Dec 28. pii: peds.2015-3876. [Epub ahead of print]


    Children and adolescents with epilepsy may experience prolonged seizures in school-associated settings (eg, during transportation, in the classroom, or during sports activities). Prolonged seizures may evolve into status epilepticus. Administering a seizure rescue medication can abort the seizure and may obviate the need for emergency medical services and subsequent care in an emergency department. In turn, this may save patients from the morbidity of more invasive interventions and the cost of escalated care. There are significant variations in prescribing practices for seizure rescue medications, partly because of inconsistencies between jurisdictions in legislation and professional practice guidelines among potential first responders (including school staff). There also are potential liability issues for prescribers, school districts, and unlicensed assistive personnel who might administer the seizure rescue medications. This clinical report highlights issues that providers may consider when prescribing seizure rescue medications and creating school medical orders and/or action plans for students with epilepsy. Collaboration among prescribing providers, families, and schools may be useful in developing plans for the use of seizure rescue medications.
    (The Roundy et al article above is not cited by this article)

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