Abstracts

Rationale: It is unclear as to what extent cognitive testing in the assessment of the seizing patient is implemented amongst first responders, specifically nurses and residents. Our goal in this study was to evaluate knowledge about assessing responsiveness during seizures to identify educational gaps. By identifying challenges in the current practice of seizure assessment, our goal is to support the use of a standardized scale that would enable efficient and thorough cognitive assessment of the seizing patient. Methods: We administered a 9-item survey to neurology residents and neurology nursing staff at our institution to evaluate knowledge about assessing responsiveness during seizures to identify educational gaps. The survey included questions related to current practices of seizure assessment. The testing of specific modalities of consciousness and preference to a standardized seizure scale was assessed using a Likert scale. The mean, median, and inter-quartile ranges were calculated and a non-parametric Wilcoxan / Mann-Whitney U test was performed to look for variations between the nurses and residents. Results: 18 of 25 neurology residents and 18 of 20 dedicated neurology nursing staff responded to the survey. There was agreement amongst residents and nursing staff about the frequency of assessment of consciousness during and after seizures. Both groups found that features inherent to seizure characteristics ('seizure is too short' or 'patient is convulsing') were most significant in limiting adequate assessment of consciousness. When questioned about current practice, it appears that memory is least likely to be tested without reaching significance. Residents tended to test memory less often than nurses (p<0.01, two-tailed test). Nurses were also significantly more in favor of having a standardized scale to administer during seizures (p<0.01, two-tailed test). Conclusions: Neurology residents and nurses realize the importance of testing for consciousness during seizures, but perceive time and seizure characteristics to be limiting factors. Memory was least likely to be tested, with residents carrying out memory testing less frequently. Nursing staff were significantly more in favor of a standardized assessment scale. A standardized scale would likely need to include all the important features of consciousness testing but also be feasibly administered.