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A nurse-led ‘first fitter’ clinic in a paediatric emergency department: an experience
  1. Kim Williams1,
  2. Richard Appleton2,
  3. Briar Stewart1,
  4. Anne Sweeney2
  1. 1Department of Accident and Emergency, Alder Children's NHS Trust, Liverpool, UK
  2. 2The Roald Dahl EEG Department, Paediatric Neurosciences Foundation, Alder Children's NHS Trust, Liverpool, UK
  1. Correspondence to Briar Stewart, Accident and Emergency Department, Eaton Road, Liverpool LA1 2AP, UK; briar.stewart{at}


Background The diagnoses of a child who presents to an Accident and Emergency (A&E) department with ‘jerking’ or loss of consciousness include an epileptic seizure, vasovagal event, cardiac syncope or other paroxysmal event. Where the likely diagnosis is a first epileptic tonic-clonic seizure, there is no consensus on how these children should be followed-up. This is important as many parents of children who experience an epileptic tonic-clonic seizure will be anxious and concerned about a recurrence and what to do if it does. A first fitter clinic (FFC) was established in the Accident and Emergency Department of our hospital to standardise the management of these children.

Methods Children presenting to the A&E department of a large children's hospital considered to have had a first tonic-clonic epileptic seizure were offered an appointment for the FFC within 3  weeks of their attendance. The clinic was supervised by an advanced nurse practitioner. Details of the child's reported tonic-clonic seizure were recorded on to a standardised proforma and additional information was obtained on other paroxysmal epileptic and non-epileptic events.

Results Altogether, 120 children were offered an appointment in the FFC, of which 117 (97%) attended. Their mean age was 9.5 (range: 3.5–15.2)years. Following review in the clinic, 82 (70.1%) of the 117 children were considered to have experienced an epileptic tonic-clonic seizure. Twenty-eight patients were considered to have had a vaso-vagal attack or reflex anoxic seizure; two, a possible cardiac arrhythmia; two a breath-holding episode and in three patients the events could not be classified.

Conclusion The FFC was well-attended suggesting that families appreciated early follow-up and the opportunity to address their concerns and provide advice about what to do if there was a recurrence. The study also demonstrated that approximately one-third of children were misdiagnosed as having experienced a tonic-clonic seizure.

  • Paediatric emergency medicine
  • clinical assessment
  • advanced practitioner
  • epilepsy
  • first tonic-clonic seizure
  • emergency care system, advanced practitioner
  • neurology, epilspsy
  • paediatrics, paediatric emergency med

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