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Intervention Time and Adverse Events in a Canadian Epilepsy Monitoring Unit

Published online by Cambridge University Press:  14 December 2020

Jimmy Li
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Dènahin Hinnoutondji Toffa*
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada Neurology Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Elie Bou Assi
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Sepehr Mehrpouyan
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Julie Forand
Affiliation:
Neurology Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Manon Robert
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Mark Keezer
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada Neurology Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
Adrien Flahault
Affiliation:
Nephrology Division, Sainte-Justine Research Center, Montreal, QC, Canada
Dang Khoa Nguyen
Affiliation:
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada Neurology Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
*Corresponding
Correspondence to: Dènahin H Toffa, MD, PhD, CSCN, Neurosciences Department, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900 St Denis Street, Montreal, Quebec H2X 0A9, Canada. Email: denahin.hinnoutondji.toffa@umontreal.ca

Abstract:

Background:

Intervention time (IT) in response to seizures and adverse events (AEs) have emerged as key elements in epilepsy monitoring unit (EMU) management. We performed an audit of our EMU, focusing on IT and AEs.

Methods:

We performed a retrospective study on all clinical seizures of admissions over a 1-year period at our Canadian academic tertiary care center’s EMU. This EMU was divided in two subunits: a daytime three-bed epilepsy department subunit (EDU) supervised by EEG technicians and a three-bed neurology ward subunit (NWU) equipped with video-EEG where patients were transferred to for nights and weekends, under nursing supervision. Among 124 admissions, 58 were analyzed. A total of 1293 seizures were reviewed to determine intervention occurrence, IT, and AE occurrence. Seizures occurring when the staff was present at bedside at seizure onset were analyzed separately.

Results:

Median IT was 21.0 (11.0–40.8) s. The EDU, bilateral tonic–clonic seizures (BTCS), and the presence of a warning signal were associated with increased odds of an intervention taking place. The NWU, BTCS, and seizure rank (seizures were chronologically ordered by the patient for each subunit) were associated with longer ITs. Bedside staff presence rate was higher in the EDU than in the NWU (p < 0.001). AEs occurred in 19% of admissions, with no difference between subunits. AEs were more frequent in BTCS than in other seizure types (p = 0.001).

Conclusion:

This study suggests that close monitoring by trained staff members dedicated to EMU patients is key to optimize safety. AE rate was high, warranting corrective measures.

RÉSUMÉ :

Temps d’intervention et survenue d’événements indésirables dans une unité de surveillance de l’épilepsie au Canada.

Contexte :

Le temps d’intervention (TI) en réaction aux crises d’épilepsie et la survenue d’événements indésirables (EI) se sont révélés des éléments très important de la prise en charge des patients dans une unité de monitoring d’épilepsie (UME). Nous avons donc réalisé un audit du suivi des patients à l’UME de notre institution, en portant une attention particulière au TI et aux EI.

Méthode :

il s’agit d’une étude rétrospective portant sur tous les cas de crise clinique d’épilepsie qui ont nécessité une hospitalisation à l’UME, sur une période d’un an, dans un centre universitaire de soins tertiaires au Canada. L’UME était elle-même divisée en deux sous-unités : la première est une section de l’unité d’explorations en épileptologie, comptant 3 lits, pour une surveillance de jour, sous la supervision de techniciens en EEG ; la seconde, qui est une sous-unité du département de neurologie (UDN), comptant 3 lits et dotée de vidéo-électroencéphalographes, est un secteur où étaient transférés les patients la nuit et les fins de semaine, sous la supervision de personnel infirmier. Les dossiers de 58 patients admis sur 124 ont été analysés, et l’examen des données a révélé la survenue de 1293 crises au total, nombre qui a servi à déterminer la fréquence des interventions, les TI et le nombre d’EI. Les crises survenues au chevet en la présence de personnel ont fait l’objet d’une analyse distincte.

Résultats :

Le TI médian était de 21,0 secondes (11,0–40,8). L’USE, les crises tonico-cloniques bilatérales (CTCB) et la notion d’alerte en début de crise ont été associées à une augmentation des probabilités d’intervention. L’UDN, les CTCB et le rang des crises (classées par ordre chronologique, par patient, dans chaque sous-unité) ont été associés à des TI plus longs. Le taux de présence du personnel au chevet était plus élevé à l’USE qu’à l’UDN (p < 0,001). Des EI sont survenus dans 19 % des cas, indépendamment des sous-unités. Toutefois, les EI étaient plus fréquents dans les cas de BTCS que pour les autres types de crise (p = 0,001).

Conclusion :

Les résultats de l’étude suggèrent qu’une surveillance étroite des patients assurée par du personnel formé, dans une USE est un facteur très important de l’optimisation de la sécurité. Le taux d’EI est élevé, ce qui justifie la prise de mesures correctrices.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc

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