Emergency department use of computed tomography in children with epilepsy and breakthrough seizure activity

Children with epilepsy are frequently evaluated in the emergency department for breakthrough seizure activity. This population is at risk for undergoing repeated computed tomography (CT) scans. The long-term health risks associated with CT scans has been the subject of multiple articles in recent years. In 2002, the National Cancer Institute released a statement that focused on reducing long-term health risks by limiting children's exposure to CT radiation. A retrospective study that included 124 children (ages 2 months-16 years) who presented to our emergency department with epilepsy and breakthrough seizure activity was performed to determine whether the National Cancer Institute statement made an impact on the number of head CT scans ordered. Physician's compliance with the American Academy of Neurology guidelines for emergent head CT scans in patients with known seizure disorder and the diagnostic yield of the head CT scans was also assessed. There was a significant increase (P = .016) in the number of CT scans performed from the years 2000-2001 to the years 2003-2004. Of the 21 children who had CT scans, 15 (71%) children did not meet American Academy of Neurology guidelines for an emergent CT scan. None of the children had an acute finding on CT, and all were discharged from the emergency department. This finding suggests that the yield of emergent CT scans in children with epilepsy and breakthrough seizure activity is low. This study demonstrates the increasing utilization of CT scans in this population at our institution and that compliance with American Academy of Neurology guidelines is not optimal.