Assessment of Compliance With the National Institute for Health and Care Excellence Guidance in the Management of Patients Referred Following a First Suspected Seizure: A Retrospective Clinical Audit

IntroductionA first suspected seizure requires timely specialist assessment and appropriate investigation to establish an accurate diagnosis, identify seizure mimics, assess the risk of recurrence, and provide appropriate safety advice.The National Institute for Health and Care Excellence (NICE) guidance recommends urgent specialist assessment following a first suspected seizure, alongside appropriate electrocardiography, electroencephalography, neuroimaging, recurrence-risk assessment, and patient safety advice.This audit evaluated adherence to these standards within a first-seizure clinic. Materials and methodsA retrospective clinical audit was undertaken on patients referred to a first-seizure clinic from the Emergency Department and Acute Medicine Unit over a three-month period from January to March 2025.Data were obtained from electronic patient records, clinic correspondence, and discharge documentation.Compliance with predefined standards from NICE guidance was assessed.The primary outcome measures were timely specialist assessment, 12-lead electrocardiography, documentation of individualized seizure recurrence risk, timely electroencephalography where clinically indicated, timely neuroimaging where indicated, and documentation of safety-netting and driving advice. ResultsSixty-three patient records were initially identified.Ten patients did not attend or were lost to follow-up and were excluded from the final clinical analysis, leaving 53 patients.Five of 53 patients (9.4%) received specialist assessment within two weeks.A 12-lead ECG was documented in all 53 patients (100%), and an individualized seizure recurrence risk assessment was documented in all patients (100%).An electroencephalogram (EEG) was indicated in 17 patients, of whom one (5.9%)underwent EEG within 72 hours; 15 (88.2%) underwent EEG after 72 hours, and one patient did not attend.The mean time to EEG among those who eventually underwent the investigation was approximately 12.5 weeks.Neuroimaging was indicated in 41 patients, of whom 22 (53.7%)underwent imaging within six weeks and 19 (46.3%) underwent imaging after six weeks.Safety-netting, including documentation of driving/Driver and Vehicle Licensing Agency (DVLA) advice, was documented in all 53 patients (100%). ConclusionThe audit demonstrated high compliance with core assessment and documentation standards but substantial delays in specialist review and time-critical investigations.The greatest gap was in timely EEG access, followed by delays in specialist assessment and neuroimaging.The findings support service-level interventions aimed at improving urgent access to first-seizure assessment and investigations.A repeat audit, following the implementation of targeted interventions, will be important to determine whether pathway changes improve compliance.