A clinical audit on febrile seizure management at the primary care unit of Lady Ridgeway Hospital for Children, Colombo

Introduction: Febrile seizures (FS) are the most common childhood seizures, categorized into simple and complex types. Simple febrile seizures (SFS), which are benign and self-limiting, account for over 70% of cases and often prompt emergency visits, sometimes leading to unnecessary investigations. Data on adherence to FS management guidelines in Sri Lanka are scarce.
Objectives: To evaluate adherence to standard FS management guidelines at the Primary Care Unit (PCU), Lady Ridgeway Hospital (LRH), Colombo.
Methods: A prospective clinical audit was conducted at LRH PCU from August 1-30, 2023, including 25 FS cases via convenience sampling. Data were collected by direct observation using a checklist. Parental counselling was assessed using an expert-validated eight-point guide.
Results: The mean age was 2.63 years, and 56% were male. They presented due to SFS in 68% and complex FS in 32%. There were two children with febrile status epilepticus. URTIs were the most common cause of fever (56%). First-time seizures accounted for 66% of admissions. Over-investigation was observed in 65% of SFS; 9.5% of eligible patients were under-admitted. Buccal midazolam (IV preparation, off-label) was the most frequently used first line.
Parental counselling was inconsistent and inadequate. It was as verbal instructions in 32% and in written form in 16%. Key educational points were incompletely addressed; epilepsy risk was never discussed. However, inappropriate prescription of intermittent prophylaxis (clobazam) was minimal.
Conclusion: The audit revealed over-investigation, under-admission, and inadequate parental counselling, highlighting the need for standardized protocols and structured caregiver education.