An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa

Abstract

Background Globally, adults presenting with seizures account for 1% – 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV ( p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24–48 h in a resource restricted setting.

Development of clinical prediction model to guide the use of CT head scans for non-traumatic Thai patient with seizure: A cross-sectional study

“…A total of 9 potential predictors were preselected based on previously reported literature, expert consensus, simplicity, and their availability in general ED [ 5 , 11 – 13 , 16 ]. Demographic data: age, gender, clinical data: Glasgow coma scale (GCS) of 8≤, 9–13, >13, new-onset focal neurological deficit (absence or presence) defined as: a set of symptoms or sign in which causation can be localized to an anatomic site in the central nervous system [ 17 ], previous CT head scans status (absence, normal or abnormal), history of malignancy (absence or presence), history of cerebrovascular accident (CVA) (absence or presence), Epilepsy (absence or presence) defined as: two unprovoked seizures occurring more than 24 h apart; a single unprovoked seizure if recurrence risk is high (ie, >60% over the next 10 years); or a diagnosis of an epilepsy syndrome [ 18 ], AWS (present or absence) defined as the present of autonomic hyperactivity (sweating, tachycardia); increased hand tremor; insomnia; nausea or vomiting; transient visual, tactile, auditory hallucinations or illusions; psychomotor agitation; anxiety; or tonic-clonic seizures caused by abruptly discontinued of previous large consumed alcohol [ 19 , 20 ].…”

“…According to surveys [ 10 ], decision support tools show promise in helping emergency physicians effectively utilize CT head scans. Many studies have demonstrated the potential factors that associated with positive finding on CT head scans such as Age, focal neurological deficit, history of malignancy, alcohol withdrawal symptoms (AWS) [ 5 , 11 – 13 ]. However, studies focusing on the utilization of these factors to develop clinical prediction tools for supporting the use of CT head scans in patients with seizures in resource-constrained settings are limited.…”

Impact of Human Resource Information System Performance for Sustainable Health Sector in South Africa

“…Studies conducted by Das and Barman (2018), as well as Mabaso (2020) on ways to introduce an HRIS that has fully assimilated HR mechanisms that can be used in the effectiveness of organisations' performance, are essential. This perhaps could deprive some organisations not able to make use of ISs such as HRIS to ascertain workers that are due for incentives for their additional effort be rewarded accordingly.…”

“…For some time now, the public healthcare sector in developing nations has yet to live up to its promises of good healthcare services. For example, Lema (2018) and Mabaso (2020) decried the state of public hospitals in South Africa (SA) and Ethiopia. Equally, Grobler, Wärnich and Mokobane (2018) and Matimbwa and Masue (2019) mentioned the lack of qualified personnel to manage public healthcare facilities.…”