Clinical Audit of Acute Seizure Management in Paediatric Patients at Kenyatta National Hospital

Abstract

Background In children, acute seizures are associated with a heightened risk of future development of epilepsy. Therefore, effective control of acute seizures is crucial in the reduction of the burden of epilepsy. Antiepileptic drugs offer seizure control in a variety of seizure disorders, epilepsy and epilepsy syndromes. Challenges in managing those with epilepsy and seizures include inappropriate use of antiepileptics due to non-adherence to treatment guidelines, intolerance to adverse effects, and lack of adequately stocked hospitals. Inadequate management of seizures can lead to poor outcomes related to cognitive and behavioural disabilities and in worst cases, death. It is therefore important to evaluate the practice of seizure management. However, presently there are no local studies outlining the current practice in seizure management or assessing the processes and outcomes of seizure management in Kenya. Objectives To conduct a clinical audit of acute seizures in paediatric patients admitted at Kenyatta National Hospital. Methods A descriptive cross-sectional study was done to find out the characteristics, management and outcomes of acute seizures among paediatric in-patients at Kenyatta National Hospital (KNH). In-patient medical records of 97 children admitted with acute seizure during the study period of December 2019 to January 2021 were sampled by consecutive sampling and data extracted. A Clinical Audit tool was developed and used to assess the structures, processes and outcomes of acute seizure management of paediatric in-patients at Kenyatta National Hospital. The results obtained for each criterion was compared to pre-set standards for each criterion. Results The patients’ records sampled consisted of 97 children with 54 of them being male and 43 being female aged between 1 month and five years who were admitted at the hospital for acute seizure management. Analysis of patient records showed that most patients had febrile seizures 56 (58%) than acute symptomatic seizures 41 (42%) that were generalized tonic clonic in nature. Bacterial meningitis was the most common 39 (41%) cause of acute seizures. The most

common AED used for initiation and maintenance dosing either as monotherapy or combination therapy was Phenobarbital. This coincides with data showing the most frequent acute seizure type to be generalized seizures as Phenobarbital is one of the recommended AEDs for seizure control. Also, most patients 70 (72%) had their seizures controlled after hospitalisation. There was poor recording of adverse drug reactions due to antiepileptic drugs and none of the patient files had this information. The clinical audit revealed that there were gaps in the safe and effective use of antiepileptic drugs during acute seizure management in paediatric patients at Kenyatta National Hospital and recommendations made to improve on areas of non-compliance. Conclusion An evidence-based tool was developed for audit of acute seizure management. This was successfully used to audit structures, processes and outcomes that characterize acute seizure management. Some criteria had full compliance to the pre-set standards such as proper assessment, classification and laboratory investigations in acute seizure management as well as having adequate staff. Areas of partial and non-compliance to set standards included lack of a few critical essential antiepileptic drugs and safe and effective use of antiepileptic drugs respectively. A quality improvement plan was developed for use by the Kenyatta National Hospital management.