EuroNASH: European Audit of Seizure management in Hospitals

Data Collection Site: Click Here        E-Mail:  euronash@liverpool.ac.uk

Epilepsy is common, and for those with an established diagnosis each presentation to an emergency department (ED) represents a “failure” in control. Also, those presenting with a first seizure require appropriate acute management and rapid access to seizures services. Ascertaining patients presenting to ED provides an opportunity to assess their acute care as well as their prior and onward care.

Whilst there are many research studies in epilepsy assessing the best treatment options for patients with epilepsy, little attention has been paid to assessing the organisation and delivery of epilepsy care at regional and national levels. In the UK, the National Audit of Seizure management in Hospitals (NASH) has had two rounds of data collection and analysis. Anonymous data have been collected on almost 9000 ED attendances from over 150 hospitals. Whilst some units were able to provide consistently good care given current resources, the audit identified unacceptable variation in the quality of care. The results have led to the prioritisation of epilepsy care by the NHS lead for neurological conditions, and a number of local project are underway to improve care pathways (http://www.hra.nhs.uk/news/research-summaries/care-after-presenting-with-seizures-caps/).

National and international audits can change care and practice. Previous experience of the study team in national audits of myocardial infarction, stroke, carotid endarterectomy, evidence-based prescribing, COPD, lung cancer, continence, inflammatory bowel disease, blood transfusion, and palliative care have shown them to be successful in improving services as the results have been fed back to sites. There has been similar success with a European COPD audit (http://www.ersnet.org/eu-activities/ers-funded-projects/item/4387-ers-copd-audit.html).

The European Union has funded a programme of work: the European Study of Burden and Care in Epilepsy (ESBACE). One of the work packages is the EuropeaN Audit of Seizure management in Hospitals (EuroNASH), which will be undertaken in a number of European countries, with data collected from at least 5 hospitals per participating country. EuroNASH seeks to assess the feasibility of a future European-wide audit, and, for those hospitals that take part, will identify any variation in patient care and some of the resource and organisational factors that may account for this. The audit data will provide a first European benchmark against which clinical teams can compare themselves now, and monitor future change.

Study Aims

The aims of EuroNASH are to:

  1. Ascertain adult cases attending EDs with an unprovoked epileptic seizure, from a range of European countries, who therefore require assessment by a neurologist or seizure expert.
  2. Audit the care provided to those adult patients. This will include audit of:
    1. Care during attendance or hospital admission
    2. Prior care from epilepsy or neurology services; and
    3. Onward care to epilepsy or neurology services
  3. To assess the feasibility of Europe-wide audit

Study Objectives

The objectives of EuroNASH are to:

  1. Identify at least 5 hospitals with ED departments in each participating European country.
  2. Identify 50 adult (aged 16 or older) ED attendances with a suspected seizure in each of those 5 (or more) hospitals.
  3. Collect anonymous data on each ED attendance about their acute care, and about their prior and onward care.
  4. Provide reports for each hospital showing how their results compare with both their national and the European average.


The University of Liverpool    The Clinical Trials Research Center    European Study on the Burden and Care of Epilepsy

Study funder

This study has been funded by the European Commission for health and food safety


EuroNASH will be overseen by a steering committee, chaired by Professor Marson, with a representative from each of the participating countries and a patient and public representative. The steering committee will report to the ESBACE Scientific Committee: Jakob Christensen (AUH, Denmark) (Chair), Anthony Marson (Liverpool UK), Torbjörn Tomson (Karolinska Institute, Sweden), Christine Linehan (University College Dublin, Ireland).


EuroNASH is an audit that collects anonymous data in order to assess the process of care in a number of European countries. This should not require individual patient consent, but may require ethical approval in some European countries

Recruiting Centres


Please feel free to contact the EuroNASH Audit team by any of the means below:


0151 529 5463


EuroNASH Audit
Room 2.30
Clinical Sciences Centre
University of Liverpool
Lower Lane
L9 7LJ