Do epilepsy specialist nurses use a similar history-taking process as consultant neurologists in the differential diagnosis of patients presenting with a first seizure?

Abstract

The development of specialist nursing practice has blurred the boundaries between medicine and nursing. This mainly qualitative study compares the structure of epilepsy specialist nurse (ESN) and consultant neurologist (CN) clinical interviews at first seizure presentation and opinion on diagnosis. Twenty patients with a suspected first seizure were randomly allocated for clinical review with an ESN and then a CN, or vice versa. Clinical interviews were unstructured and audio-recorded. The ESN and CN reached an independent diagnosis for each patient. Audiotapes were transcribed verbatim. Emergent themes were identified, catalogued and grouped into major thematic areas. Annotated audio recordings, medical notes and dictated clinic letters were used to validate findings. Statistical analysis of inter-rater agreement of diagnosis was evaluated using Kappa. The clinical interviews of CN and ESN were similar in structure. Differences demonstrated CNs concentrated on the prodrome to events and expressed less diagnostic uncertainty. ESNs concentrated on post-ictal recovery and used more investigations. Complete disagreement on diagnosis occurred in 5 (25%) patients. Kappa score = 0.510, demonstrating a moderate level of inter rater agreement on diagnosis between the CN and ESN.