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Management of febrile convulsion: scene in a regional
hospital
KL Kwong, KS Tong, KT So
Department of Paediatrics, Tuen Mun Hospital, Tsing Chung Koon Road,
Tuen Mun, Hong Kong
OBJECTIVE. To determine whether practice parameters
are applied to the management of children with febrile convulsion.
DESIGN. Retrospective study.
SETTING. Paediatric department of a public hospital,
Hong Kong. METHODS. Practice parameters of the American Academy
of Pediatrics and audit measures recommended by the Joint Working
Group of the Research Unit of the
Royal College of Physicians and the British Paediatric Association
were employed as standards. Records between January and April 2000
with the diagnostic coding of febrile convulsion, convulsion, status
epilepticus, or meningitis/encephalitis/encephalopathy were reviewed.
Areas assessed were appropriate documentation of hospital records
and unit statistics (adverse outcomes, inappropriate investigations
and treatment).
RESULTS. Ninety-four consecutive records were evaluated.
In the documentation of hospital notes, accurate description of
seizure was observed in 92%, incorrect diagnosis or coding in 12%,
and presence/absence of signs of meningitis and parental counselling
documented in 64% and 85%, respectively. Regarding unit statistics,
investigations performed included a complete blood count, blood
glucose, serum calcium, serum electrolytes, renal function tests,
liver function tests, chest X-ray, and urinalysis. The mean number
of routine investigations was seven. The average length of stay
was 2 days. There were no cases of delay in the diagnosis of central
nervous system infection. Inappropriate investigations and treatment
were as follows: electroencephalography 11%, computer tomography
brain scan 2%, and maintenance anticonvulsants 2%. All patients
were discharged home with panadol regardless of clinical state.
CONCLUSIONS. The present study showed that the use
of unnecessary investigations was common. Investigations, though
resulting in significant expense, proved to be of little diagnostic
value. Diagnostic procedures should be performed only when specifically
called for by the patient's condition or medical history.
Hong Kong Med J 2003;9:319-22
Key words: Medical audit; Seizures, febrile
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