Evidence map›Paper›PMID 30782132›Full record

ArticleBMC neurology2019

Promoting faster pathways to surgery: a clinical audit of patients with refractory epilepsy.

Virginia Mumford, Frances Rapport, Patti Shih, Rebecca Mitchell, Andrew Bleasel, Armin Nikpour, Geoffrey Herkes, Amy MacRae, Melissa Bartley, Sanjyot Vagholkar and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
2.3field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 20 citations in OpenAlex.

  1. Disparities in pediatric drug-resistant epilepsy care.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

Virginia MumfordAustralian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. virginia.mumford@mq.edu.au.ORCID http://orcid.org/0000-0001-7915-0615
Frances RapportAustralian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Patti ShihAustralian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Rebecca MitchellAustralian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Andrew BleaselUniversity of Sydney, Sydney, Australia.
Armin NikpourUniversity of Sydney, Sydney, Australia.
Geoffrey HerkesUniversity of Sydney, Sydney, Australia.
Amy MacRaeRoyal Prince Alfred Hospital, Sydney, Australia.
Melissa BartleyWestmead Hospital, Westmead, Australia.
Sanjyot VagholkarPrimary Care & Wellbeing, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Jeffrey BraithwaiteAustralian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Macquarie University · AUThe University of Sydney · AURoyal Prince Alfred Hospital · AUWestmead Hospital · AU

Funding

Macquarie University GT00503
6 · The paper itself

Abstract

backgroundIndividuals with epilepsy who cannot be adequately controlled with anti-epileptic drugs, refractory epilepsy, may be suitable for surgical treatment following detailed assessment. This is a complex process and there are concerns over delays in referring refractory epilepsy patients for surgery and subsequent treatment. The aim of this study was to explore the different patient pathways, referral and surgical timeframes, and surgical and medical treatment options for refractory epilepsy patients referred to two Tertiary Epilepsy Clinics in New South Wales, Australia.

methodsClinical records were reviewed for 50 patients attending the two clinics, in two large teaching hospitals (25 in Clinic 1; 25 in Clinic 2. A purpose-designed audit tool collected detailed aspects of outpatient consultations and treatment. Patients with refractory epilepsy with their first appointment in 2014 were reviewed for up to six visits until the end of 2016. Data collection included: patient demographics, type of epilepsy, drug management, and assessment for surgery. Outcomes included: decisions regarding surgical and/or medical management, and seizure status following surgery. Patient-reported outcome measures to assess anxiety and depression were collected in Clinic 1 only.

resultsPatient mean age was 38.3 years (SD 13.4), the mean years since diagnosis was 17.3 years (SD 9.8), and 88.0% of patients had a main diagnosis of focal epilepsy. Patients were taking an average of 2.3 (SD 0.9) anti-epileptic drugs at the first clinic visit. A total of 17 (34.0%) patients were referred to the surgical team and 11 (22.0%) underwent a neuro-surgical procedure. The average waiting time between visit 1 to surgical referral was 38.8 weeks (SD 25.1), and between visit 1 and the first post-operative visit was 55.8 weeks (SD 25.0).

conclusionThe findings confirm international data showing significant waiting times between diagnosis of epilepsy and referral to specialist clinics for surgical assessment and highlight different approaches in each clinic in terms of visit numbers and recorded activities. A standardised pathway and data collection, including patient-reported outcome measures, would provide better evidence for whether promoting earlier referral and assessment for surgery improves the lives of this disease group.

Indexed as

Referral and ConsultationAdultAustraliaClinical AuditDelivery of Health CareDrug Resistant EpilepsyFemaleHumansMaleMiddle AgedNeurologyTime-to-TreatmentClinical auditNeurosurgeryPatient pathwaysRefractory epilepsySurgical assessment

Identifiers

PMID30782132
PMCPMC6381714
OpenAlexW2923244485

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.