Epilepsy is the most common chronic neurological disease in children, affecting between 0.5 to 1 per cent of all children.

In a newly published analysis of epilepsy diagnoses in Norwegian children, however, fully one-third of children had been incorrectly diagnosed, as reported by the Norwegian Institute of Public Health (FHI) and colleagues in a study recently published in the journal Pediatrics.

“It’s scary that there are so many people who seem to have received a diagnosis of epilepsy without actually having the disease,” said Henrik Peersen, General Secretary at the Norwegian Epilepsy Association, in response to the findings.

“We have long suspected that there are errors in the diagnosis of epilepsy,” he added. “But this can cause problems the other way, in as much as children may not be properly investigated to see if they have epilepsy.”

A rich database provides clues

The researchers used data from the Norwegian Mother and Child Cohort Study. The cohort study includes questionnaires that were regularly filled out by mothers with children born between 1999 and 2009. The questionnaires asked mothers about many different illnesses, including epilepsy.

The study population included 112,744 children from the cohort study who were aged 3 to 13 years at the end of follow-up by the registry on 31 December 2012. The researchers then compared information on these children with the questionnaires filled out by their mothers and to diagnoses that were recorded in the Norwegian Patient Registry.

After the diagnoses had been quality checked, the researchers found that one-third of the children did not meet the criteria for an epilepsy diagnosis. Only 587, or 65.6 per cent, of the 896 children who were either reported or recorded as having epilepsy actually had the disease, according to its classical definition.

“Three-hundred and nine children were recorded as having a diagnosis of epilepsy, even though they did not meet the criteria,” said Kari Modalsli Aaberg, a pediatrician at the Norwegian Institute of Public Health who was head of data collection for the study and its first author.

The classic definition of epilepsy that applied during the study period is that the child must have had at least two unprovoked epileptic seizures at least 24 hours apart.

“It appears that there is a low threshold for referring children to be checked for epilepsy in Norway. The high number of unconfirmed diagnoses may be the explanation for this,” Aaberg said.

Coding errors and different types of seizures

The researchers think one reason so many children had the wrong diagnosis might be from incorrect coding in the Norwegian Patient Registry.

Most of the children who did not meet the criteria for epilepsy had experienced other kinds of seizures, such as those caused by high fevers, or related non- unspecific episodes of “being absent” or other neurological or developmental disorders.

“The study shows that epilepsy can be a difficult diagnosis to make in children,” says Aaberg.

She said, however, that it is important to have correct figures on the occurrence of epilepsy in order to plan follow-up of these children.

Unclear how some diagnoses were made

One-third of the children in the study had received a tentative diagnosis by a clinician during an investigation of suspected epilepsy. One-third had been diagnosed after an EEG examination (examination of the brain’s electrical activity).

“When a doctor makes a diagnosis of epilepsy, he or she is required to contact the specialist health service. In many of the patient journals we found a question mark next to epilepsy, which showed that the doctors thought the diagnosis was tentative. The code for epilepsy was used not only in confirmed cases of epilepsy, but also in some children diagnosed with suspicion of epilepsy,” Aaberg said.

Many of these children were found to not to have epilepsy during a subsequent investigation, so that the clinical conclusion was then that the child did not have epilepsy.

But the researchers were unable to find out where or from whom the diagnoses came for just under a third of the children.

Some children given medications for no reason

Among the 309 children who were incorrectly diagnosed with epilepsy, 57 of them had been given epilepsy medication. The parents of these children were informed of the diagnosis, but the researchers interviewed only 60 per cent of the parents. Therefore, they do not know how many parents in total thought their child had epilepsy even though the child did not.

“Those who were medicated accounted for 18 per cent of the children who were mistakenly diagnosed. These may have been children for whom the suspicion of epilepsy was strong, but that later turned out not to have epilepsy,” Aaberg said.

The study was a collaboration between the Norwegian Institute of Public Health, Oslo University Hospital, the Akershus University Hospital, University of Bergen, University of Edinburgh and Royal Hospital for Sick Children in Edinburg.

(sciencenordic)

Rolls-Royce has secured a contract to provide a mooring system for Statoil’s oil platform Njord A, which is being upgraded by Norway-based engineering and construction service provider Kvaerner.

The platform is located in the Njord oilfield, approximately 130km northwest of the city Kristiansund and 30km west of the Draugen field.

Rolls-Royce will upgrade Njord A’s current 12-point mooring system to a new 17-point system under the new £15m deal.

Rolls-Royce customer and services marine director Knut Hovland said: “We are proud to be part of this extensive upgrade programme.

“It is the first time in the Norway’s history as an oil producing country that a platform is being towed to shore for an extensive upgrade. Previous upgrades have been done offshore.”

Njord A is a semisubmersible floating steel platform, which features an integrated deck with drilling and processing facilities, as well as living quarters.

Rolls-Royce will provide low pressure hydraulic driven winches, fairleads and a control system for the four-column production platform, which will then it will be moored at about 330m water depth following installation.

Rolls-Royce is expected to deliver the system next year, and the platform is scheduled to re-commence its operations in 2020.

The latest upgrades are expected to allow the platform to serve for additional 20 years, and form part of the wider ‘Njord Future’ initiative being carried out by Statoil, which aims to increase the lifespan of the Njord field. Kvaerner originally delivered Njord A in 1997.

The topside of the platform was developed at Stord and the hull was built at Verdal, both located on the west coast of Norway.

(offshore-technology)

Norway has begun testing of the braking parachute it will employ on its fleet of Lockheed Martin F-35As.

Initial efforts at Edwards AFB in California will focus on how the Joint Strike Fighter handles with the parachute fitted, as well as braking on both dry and wet runways. A later phase, running until early 2018 at Eielson AFB in Alaska, will evaluate its performance on icy runways.

All trials will be performed with test aircraft AF-2, the Norwegian defence ministry says.

It is sharing the development and integration costs for the system with the Netherlands, which is also acquiring the conventional take-off and landing F-35A.

Modifications include strengthening the fuselage and adapting the aircraft to house the parachute between the two tailfins.

Olso cites the extreme weather conditions its aircraft typically operate in – which include low temperatures, strong winds, poor visibility and slippery runways – as key reasons for needing the parachute.

“Being able to operate fighter aircraft under varying weather conditions is critical for our operational capability,” says defence minister Øystein Bø.

The first F-35 will arrive in Norway in November 2017, the ministry says.

(N.C2, flightglobal)

A new study shows that there were more surgical errors in Norwegian hospitals than in Swedish ones in 2013. Ninety of the Swedish and Norwegian patients whose journals were used in the study died from what are categorised as “adverse events”.

It’s no joke that the most dangerous place to be is a hospital. In Norway some 13 percent of hospital patients suffered some form of hospital injury, or adverse events, as they are called in the study. In Sweden there were a few more – 14.4 percent.

The study was recently published by the British Medical Journal website BMJ and used nearly 11,000 Norwegian patients’ medical records and a little over 19,000 Swedish patient records, all from 2013.

The researchers compared serious and less serious patient injuries and errors in the two countries. All in all the risks were fairly equal.

But certain differences in frequency were seen in the types of injuries patients can suffer when hospitalised in either of the two Scandinavian countries.

More complications after surgery

A considerably larger share of Norwegian patients suffered surgical complications.

Records showed that some 0.9 percent of patients operated on in Swedish hospitals suffered surgical complications. The share in Norway was over twice as high, at 1.9 percent.

A higher share of Norwegian patients also suffered severe surgical complications.

“More patients suffered from errors that left them with permanent injuries. This can probably be attributed to a higher number of surgical complications here,” says Researcher Ellen Tveter Deilkås at Akershus University Hospital (Ahus).

Deilkås is chief physician, researcher and project leader of the Ahus health services research unit.

While 0.7 percent of Norwegian patients suffered permanent injuries, just 0.4 percent of Swedish patients were so unfortunate.

Norwegian patients were generally more apt to develop pneumonia than their Swedish counterparts.

More bedsores in Sweden

Swedish patients, however, were more likely to suffer bedsores, injuries from falls and other unspecified adverse events.

Among other things, relatively twice the share of Swedish patients (1.2 percent) ended up with pressure ulcers than Norwegian patients.

But the study indicates that Swedish surgeons might be said to have steadier hands.

Patient injuries are defined as accidental physical harm caused my medical treatment which requires extra supervision, extra treatment or whole new hospital admittance.

Causing 90 patient deaths

The study covers everything from infections and allergic reactions to more serious injuries such as blood poisoning, pneumonia infections from breathing apparatuses and in worst case – deaths.

The injuries are grouped according to the treatment they require, whether they lead to a longer stay in hospital, cause permanent disabilities and injury, trigger the need for life-saving procedures or lead to a patient’s death.

Such fatal consequences were suffered by about 0.3 percent of the patients. This rate was about the same in both countries. In other words, in 2013, 90 of the random Norwegian and Swedish patients covered by the study died from mistakes in treatment.

If this sum is multiplied by the total number of hospital admittances that year, we can estimate that nearly 5,700 Norwegian and Swedish patients die in hospitals because of patient injuries annually.

Urinary tract infections

Urinary tract infections are clearly the most common adverse events in total, affecting 220 patients in Norway in the random selection of records from 2013.

“If we multiply this by the total number of hospital admittances, this means nearly 12,000 Norwegian patients annually suffer urinary tract infections contracted in hospitals,” says Deilkås.

In the Swedish selection of patients – nearly twice as large as there are about twice as many Swedes as Norwegians – 285 contracted urinary tract infections.

In total the analysis was based on about 11,000 Norwegian hospital patient medical records and 19,000 Swedish ones.

What causes the differences?

What could be causing the differences between Sweden and Norway?

“We don’t have that information. But we do know that the nursing factor is lower in Sweden than in Norway,” says Deilkås.

She thinks this could explain why Swedish patients are more prone to bedsores and injuries from falls.

The difference in surgical injuries might be attributed to Sweden getting an earlier start in the centralisation of hospital functions, according to the researcher. Centralisation generally involves the shutting down of smaller local hospitals.

“The centralising of surgery started later in Norway and the degree in which we centralise functions is politically controversial. But this could possibly lead to a decrease in such injuries in Norway,” she says.

More operations per capita in Norway?

It is also possible that a greater share of hospital patients in Norway undergo surgery than in Sweden.

“We haven’t investigated this,” says Deilkås.

The researchers think the study should be appeal to Swedish and Norwegian authorities to ensure better patient safety.

The Norwegian-Swedish study was conducted on the initiative of the Nordic Council of Ministers. The idea was to chart differences as a step in finding ways of reducing injuries incurred in hospital.

The Norwegian Government launched a national patient safety campaign in in 2011 to raise competence and reduce patient injuries.

Third largest cause of death

In another study published by BMJ in May 2016, researchers at Johns Hopkins Hospital in Baltimore, Maryland, found that medical errors comprise the third biggest cause of death in the USA, after cardiovascular disease and cancer. Chronic obstructive pulmonary disease (COPD) is in fourth place.

They estimated that 251,000 American deaths can be attributed to medical errors.

“This is not news to the medical profession,” asserts Ellen Tveter Deilkås.

The American researchers call for the opportunity to freely report such fatal errors in the USA’s national causes of death statistics.

(sciencenordic)