Background Little is known about the organisation and delivery of epilepsy care in the UK. The National Audit of Seizure management in Hospitals (NASH) is the first comprehensive UK-wide epilepsy audit.
Methods NASH assessed the immediate care, onward care pathways and prior care of patients attending Emergency Departments with seizures. Sites provided anonymous data on 30 consecutive cases via a bespoke web-based database.
Results Data were collected from over 3750 patients across 127 sites in the UK (mean age=45.8 (SD 19.9), 57% male). Results show considerable variability, with a few sites performing well demonstrating that good care is possible. But overall, assessment on arrival was inadequate, routine measurements were not done (temperature in only 83% of patients), a proper neurological examination with plantar responses recorded in 37% (IQR 20.0–49.1), an attempt to gain an eyewitness description in 58% (IQR 43.3–73.3), and an ECG performed in 59% (IQR 43.3–75.8). Only 51% of first seizure patients were referred for any form of neurology specialist assessment.
Conclusions Basic care currently provided shows wide variability and in many centres is inadequate to achieve good patient outcomes. Neurologists have to engage with acute services to improve this.