KL Kwong, WK Chak, KT So

Abstract

Basic standards for the process of paediatric epilepsy care were identified and applied in a clinical audit. Recommended elements of good practice include quality of prescribing practice, medical records, use of neuroimaging and requests for electroencephalogram (EEG). We reviewed medical records for patients with newly diagnosed epilepsy and requests for EEG. Four standards regarding epilepsy care were met in 100% and seven out of 8 standards were met in 75% of cases. Documentation of advice given to parents about possible side effects of drugs was only recorded in 13% of patients. The prescription of first line antiepileptic drugs and adequate dosage before considering a first line drug to have failed was achieved in 100% of our patients. One third of clinicians ordering EEG for the purpose of diagnosing epilepsy or convulsion. Requests were considered appropriate in 37% of cases. The present study suggested that we could improve our patient management in better provision and documentation of parental education concerning side effects of drug. Practical advice and recommendations were required in the role and clinical relevance of EEG.

探索兒童癲癇診療方法的基本標準，並將之應用於本門診調查。建議良好的門診應包括規範處方、病歷書寫、腦影像學應用及腦電圖申請四個方面。我們複查了新近診斷為癲癇的病人的病歷及腦電圖申請單。 100% 病人符合癲癇診療的 4 個標準，而 75% 符合 8 個標準中的 7 個。只有 13% 的病人病歷包含了旨在給予患兒父母的關於藥物可能副作用的指引。 100% 的病歷都記載了一線抗癲癇藥物及其合適的劑量（在判定其無效之前）。 1/3 的門診醫生對癲癇或抽搐患兒申請了腦電圖診斷性檢查，而僅 37% 的腦電圖申請被判定為適宜的。本研究結果提示，通過對患兒父母提供關於藥物副作用的更好的教育與醫療記錄，我們可以改善病人的診療質量。另外，對於腦電圖的作用和臨床相關性，亦需給予實用性指引。