Audit data collection tool to monitor implementation of the CPG for management of CSE in children.
| Items done and documented in the patient medical records | |||
|---|---|---|---|
| Diagnosis | |||
| Date of birth (DOB): | - - / - - / - - - - (day/month/year) | ||
| Type of patient | ◻New onset seizures ◻Known patient with seizures | ||
| Type of seizures | ◻Generalized | ◻Focal | |
| Anti-epileptic drug (AED) levels done | ◻YES | ◻NO | ◻Not Indicated |
| Toxicology screening done | ◻YES | ◻NO | ◻Not Indicated |
| Blood cultures done | ◻YES | ◻NO | ◻Not Indicated |
| Lumbar puncture (LP) done | ◻YES | ◻NO | ◻Not Indicated |
| Electroencephalography (EEG) done | ◻YES | ◻NO | ◻Not Indicated |
| Neuroimaging studies done: | |||
| CT | ◻YES | ◻NO | ◻Not Indicated |
| MRI | ◻YES | ◻NO | ◻Not Indicated |
| Treatment | |||
| Response to First-line therapy (Benzodiazepines): | ◻YES | ◻NO | |
| Response to Second-line therapy (Phenytoin): | ◻YES | ◻NO | |
| Response to Third-line therapy (Phenobarbitone): | ◻YES | ◻NO | |
| Response to Alternative therapy: | ◻YES | ◻NO | |
| Type of medication | |||
| Levetiracetam | ◻YES | ◻NO | |
| Valproic acid | ◻YES | ◻NO | |
| Response to Fourth-line therapy:- | |||
| Midazolam Infusion | ◻YES | ◻NO | |
| Thiopental Infusion | ◻YES | ◻NO | |
| Pentobarbital Infusion | ◻YES | ◻NO | |
| Admission to PICU | ◻YES | ◻NO | |
| Intubation/ Ventilation needed | ◻YES | ◻NO | |
| Length of stay (LOS) (Days/Hours):- •Department of Emergency Medicine (DEM) • Pediatric Intensive Care Unit (PICU) • Inpatient ward • Total LOS | --/-- --/-- --/-- --/-- | ||
| Patient outcome | ◻Discharged | ◻Died | |
| Follow up appointment in the Pediatric Neurology Clinic provided: | ◻YES | ◻NO | |