Abstracts

Rationale: Post-ictal phenomena in epilepsy is commonly acknowledged to be a source of morbidity with regard to quality of life. There is a paucity of literature documenting the associated demographics, frequency, types, and duration in children. This report presents these findings derived from a large sample of children presenting to a regional children's hospital. Methods: Patients were ascertained from the electronic health record (Sunrise Clinical Manager v5.0 - v15.1; Allscripts Inc.) at Alberta Children's Hospital (ACH), Calgary, AB. It is the primary referral center for community family practitioners and pediatricians. Inclusion criteria: All patients seen between Nov 28, 2014 to May 31, 2016, inclusive, who had a Pediatric Epilepsy Consult Note entered. From this population, records in which the presence or absence of delayed recovery to normal following a seizure was indicated were included. Analysis: It was the intent to consider information from the first contact record. However, data review found that the same patient could have > 1 first contact coded. Thus, the total number of "New Consultation" exceeds the total number of unique patients. Results: A total of 1780 unique patients (951 male) were seen during the above time period of which 701 patients (39%) (391 male) generated 'Consult Note' documents where 'Visit Type' was recorded as 'New Consultation' (19%). This abstract considers only these patients. Table 1 displays the number of unique Patients with "New Consult" documents and reported "Return to baseline" values: 'Immediate' 260 (31%), 'Not Immediate' 280 (33%), No response= 'Null' 309 (36%). No significant gender differences were noted. Table 2 demonstrates that there was no significant relationship between seizure frequency (SF) and return to baseline until SF of one or more seizures per day were reported. At that frequency, the ratio of Immediate: 'Not Immediate' return to baseline was > 2:1. Seizure type at the level of focal or generalized does not predict the presence of a 'Not Immediate' postictal period as this was found in 68% (164/242) and 78% (102/188) respectively. Conclusions: 1. Despite providing a structured field for indicating patient status in the post-ictal period, it was not recorded in approximately 1/3 of patients. 2. Although 'New Consultation' was intended only for the first contact, it was used more than once in multiple patients. This and the finding above indicate the importance of auditing structured EHR notes for compliance and subsequent education. 3. Approximately 1/3 of patients do not return to baseline after a seizure. This finding needs to be considered cautiously given the noted issues with data recording, but provides some estimate of the frequency of the occurrence. 4. The relationship between the post-ictal period, seizure frequency and type is complex and requires further exploration. However, it is interesting that SF rather than seizure type was associated with delayed recovery. Funding: Alberta Children's Hospital Foundation Department of Pediatrics, University of Calgary