Referral Patterns of Family Physicians May Allow Population-Based Incidence Studies of Childhood Epilepsy

Authors

  • Kathy Nixon Speechley,

    Corresponding author
    1. Child Health Research Institute, The University of Western Ontario, London, Ontario, Canada
    2. Departments of Paediatrics, The University of Western Ontario, London, Ontario, Canada
    3. Departments of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
      Address correspondence and reprint requests to Dr. K. N. Speechley at Child Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada.
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  • Simon D. Levin,

    1. Child Health Research Institute, The University of Western Ontario, London, Ontario, Canada
    2. Departments of Paediatrics, The University of Western Ontario, London, Ontario, Canada
    3. Departments of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada
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  • Samuel Wiebe,

    1. Departments of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
    2. Departments of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada
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  • Warren T. Blume

    1. Departments of Paediatrics, The University of Western Ontario, London, Ontario, Canada
    2. Departments of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada
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Address correspondence and reprint requests to Dr. K. N. Speechley at Child Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada.

Abstract

Summary: Purpose: To evaluate the burden of illness of childhood epilepsy on patient, care giver, and society, representative incidence cohorts must be followed longitudinally. Case ascertainment through pediatricians and neurologists would be a valid method if family physicians refered all new cases of childhood epilepsy. The study objective was to determine whether family physicians' physicians patterns in Southwestern Ontario make it possible to conduct a population-based incidence study of childhood epilepsy by sampling only from specialists' specialists.

Methods: Of the 1,718 family physicians practicing in South-western Ontario, a systematic sample participated in a mailed survey. Case simulations describing seven types of childhood seizures were presented to physicians with instructions to respond as to whether they would investigate/manage without referral; refer to a specialist only if problems occurred; or refer to a specialist always.

Results: Of 214 family physicians, 185 (86.4%) returned completed surveys; 86% would not refer a child with a febrile seizure. Referral to a specialist would be made always by 93% of family physicians for patients with status epilepticus, 95% for worsening partial epilepsy, 82% for a first, brief, generalized clonic seizure, 80% for absence epilepsy, and 99% for neonatal seizures. Only 50% of family physicians would always refer a neurodevelopmentally abnormal child with generalized clonic epilepsy, but a further 37% would refer if problems occurred.

Conclusions: It is feasible to recruit a representative population-based cohort of recently diagnosed patients for epide-miologic studies of childhood epilepsy by surveying pediatricians and neurologists. These survey results could be used to adjust estimates of incidence obtained through specialists' specialists for the bias in case ascertainment that may result from this practical method.

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