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New onset childhood seizures. Emergency department experience
N Landfish1, M Gieron-Korthals, R E Weibley
1University of South Florida College of Medicine, Tampa.
Insights
New onset seizures in children, especially those under two, are often febrile. A detailed history and physical exam are more effective than extensive lab tests or CT scans for diagnosis in the pediatric emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Clinical Diagnostics
Background:
- New onset seizures are a common pediatric emergency department (ED) presentation.
- Accurate and efficient diagnosis is crucial for appropriate management and disposition.
- Previous studies have varied in their recommendations for diagnostic workup.
Purpose of the Study:
- To retrospectively assess the efficiency of diagnostic workup for new onset seizures in a pediatric ED.
- To determine the utility of laboratory tests and neuroimaging in this population.
- To identify key historical and physical examination findings predictive of etiology.
Main Methods:
- Retrospective chart review of 56 pediatric patients presenting with new onset seizures over one year.
- Analysis of patient demographics, seizure characteristics, etiology, laboratory results, and imaging findings.
- Correlation of diagnostic findings with final diagnoses and patient outcomes.
Main Results:
- The majority of patients (69%) were under two years of age.
- Febrile seizures constituted the most common etiology (71%), followed by idiopathic (21%) and symptomatic (7%).
- Significant laboratory abnormalities were rare (7%), and screening tests like brain CT scans were generally unhelpful.
Conclusions:
- A thorough patient history and complete physical examination are paramount for diagnosing new onset seizures in children.
- Extensive laboratory and radiologic workup is often unnecessary in the pediatric ED setting.
- Focusing on clinical assessment can improve diagnostic efficiency and resource utilization.
Abstract:
Fifty-six cases of new onset seizures evaluated in a pediatric emergency department (ED) during a one-year period were assessed retrospectively for efficiency of diagnosis and workup. The majority of patients (69%) were less than two years of age. Based on etiology, the most common seizure type was febrile (71%) followed by idiopathic (21%) and symptomatic (7%). Significant laboratory abnormalities were found in four (7%) patients; two had hyponatremia, one carbamazepine overdose and one bacterial meningitis. Screening laboratory tests including brain CT scans were generally not helpful. A thorough history including specific details regarding the seizure and a complete physical examination should eliminate the need for major laboratory and radiologic workup in the emergency department.