单一癫痫临床模型:工作吗?对等待时间和病人的影响结果(S6.005)

文摘

目的:比较专业的有效性urgent-access单没收诊所(SSC)与标准治疗。背景:照顾患者癫痫发作是支离破碎的。未知的专业诊所改善病人的治疗结果是否需要检查癫痫(s)。没有高质量的证据来描述SSC有效性。设计/方法:前瞻性研究200例患者被称为我们的SSC首次发作评估。人口统计学、临床和paraclinicial变量对历史进行分析控制。二元逻辑回归分析预测进行一分为二的影响变量在预测癫痫。结果:意味着病人年龄为42.1岁(范围14 - 88)。推荐来源主要是急诊科和家庭医生。第一次接触的诊断成立80.9 (percnt)的情况下。 16.1[percnt] of patients required a second a visit. 0.5[percnt] of patients required three consultations. 82/200 (41[percnt]) patients were diagnosed with epilepsy. Syncope was found in 24.5[percnt], single unprovoked seizure in 14.4[percnt], and alcohol withdrawal seizures in 4.6[percnt]. Mean wait-time for first assessment was reduced by 71[percnt] (23.6 SSC versus 80.1 days standard care). Mean wait-time for an EEG was 4.0 days (37.1 days standard care). In 134/200 cases a CT scan had been performed. The wait-time for an MRI requested by the SSC was 44.9 days (81.3 days standard care). 63 patients were started on anti-epileptic drugs, with 63.50[percnt] starting lamotrigine, 7[percnt] levetiracetam, 5[percnt] phenytoin, and 5[percnt] topiramate. Presence of generalized spike-wave discharges (odds-ratio (OR)=12.8;CI:5.3-30.7;p<0.00) or focal spike-wave (OR=6.8;CI:1.9-23.6;p=0.003), tongue trauma (OR=6.3;CI:2.9-13.9;p<0.001), and pre-assessment stratification as high risk for seizure recurrence (OR=4.3;CI:1.7-10.9;p=0.002) strongly predicted epilepsy. SSC physicians were 17.1 more likely to accurately diagnose epilepsy versus nurses; there was a non-significant correlation between physician and nurse diagnoses. CONCLUSIONS: The SSC reflects an effective platform for single point-of-access care for seizure workup. This model reduces wait-times, improves patient access,and streamlines care.

披露:Syed博士没有披露。Hernandez-Ronquillo博士没有披露。亨特博士没有披露。博士Moien Afshari没有披露。沃特豪斯博士没有披露。泰雷兹Zenteno博士获得了研究拉斯顿兄弟的支持信任。