K L Kwong1, K S Tong, K T So. 1. Department of Paediatrics, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong, ROC. maksk@ha.org.hk
Abstract
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%, computed 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.
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%, computed 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.