Practice Parameters in Child Neurology: Do Pediatricians Use Them?

Abstract

We assessed pediatrician awareness of the parameter ''Evaluating the first non-febrile seizure in children'' and how the concepts of this parameter were incorporated into practice. Although most reported caring for children with seizures, 60% were not aware of the practice parameter. When given the clinical scenario of an otherwise healthy 8-year-old child with a first, unprovoked seizure, management was variable. Most (83%) would obtain an electroencephalography, and many (58%) would order an imaging study, usually a magnetic resonance imaging. However, most were also likely to order laboratory studies that were not indicated given the scenario and the practice parameter. This pilot study suggests that pediatricians may not be aware of this practice parameter and many may not be incorporating evidence-based recommendations regarding the evaluation of children with new-onset seizures.

Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy

“…However, the available literature agrees on the main management recommendations that have been summarized in a flowchart that is being evaluated for implementation at our institution (Figure 3). 39,63,65,66 Because these recommendations have not always been implemented in clinical practice, 67,68 and in the setting of revised diagnostic criteria for epilepsy, it may be worthwhile to reiterate and adjust the approach to new-onset seizures.…”

What Is Quality Improvement and Why Should Child Neurologists Care?

“…40 Nevertheless, fully 60% of pediatricians were not aware of the practice parameter, and a similar percentage reported they would order an imaging study for the child who presented with his or her first nonfebrile seizure. 56 Some insurers appear to believe that clinical practice guidelines devised by well-intentioned professional societies will improve care and save money and so will pay for care based on how closely those guidelines are followed. 57 The overreliance on expert opinion and guidelines has been decried.…”

Advocacy for children with epilepsy: Leveraging the WHA resolution. Advocacy Task Force, Commission of Pediatrics, International League Against Epilepsy

“…To implement and adapt epilepsy guidelines (or recommendations), local resources and needs must be understood, including an assessment of locally prevailing causative factors and barriers to care. National health care plans will not be viable if implementation does not include local adaptation . Examples of guidelines that are well developed and constantly reviewed and adapted are those produced by the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the practice parameters of the American Academy of Neurology (AAN) and the American Academy of Pediatrics (AAP) in the United States, and the updated 2016 WHO guideline Pediatric Emergency Triage Assessment and Treatment (ETAT) .…”