Management of children with nonfebrile seizures in the emergency department
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Published on: September 20, 2024
Yuval E Landau1, Yehezkel Waisman, Avinoam Shuper
1Neurology Unit, Schneider Children's Medical Center of Israel, Petah Tiqwa, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. yuvaland@post.tau.ac.il
Insights
A targeted approach for pediatric nonfebrile seizures, including electroencephalography and neurologist consultation, can reduce hospitalizations and healthcare costs. This strategy spares children unnecessary tests and improves emergency department efficiency.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Management
Background:
- Emergency department evaluations for pediatric seizures often involve physicians lacking specialized knowledge in pediatric epileptology.
- Current work-ups are frequently extensive, costly, and contribute minimally to final clinical decisions.
Purpose of the Study:
- To analyze the emergency department management of children presenting with nonfebrile seizures.
- To determine the optimal role for neurology clinics in managing these cases.
Main Methods:
- Retrospective review of 104 emergency department visits for nonfebrile seizures in 85 children at a pediatric tertiary hospital.
Main Results:
- Electroencephalography and neurology consultations were the only interventions significantly influencing management decisions.
- Despite 71% of cases recommending hospitalization, it was typically short-term with minimal impact on overall patient management.
- Extensive testing, including blood work and brain imaging, was common but often yielded limited diagnostic value.
Conclusions:
- A focused, problem-oriented approach for nonfebrile seizures in children is recommended.
- Integrating essential work-up, such as electroencephalography, with specialist neurology consultation can reduce hospital admissions and healthcare expenditures.
- This strategy aims to minimize unnecessary diagnostic procedures for pediatric patients.
Background:
Children with seizures are often referred to the emergency department where they are typically evaluated by a physician with limited knowledge of pediatric epileptology and undergo a costly and extensive work-up that contributes little to the final decision.
Aim:
The aim of this study was to examine the medical management of children with nonfebrile seizures in the emergency department and to define the potential role of the neurology clinic in this context.
Materials And Methods:
The files of 85 children who made 104 visits to the emergency department of a pediatric tertiary hospital for nonfebrile seizures were retrospectively reviewed.
Results:
Average age was 7.5 years. Blood tests were performed in almost all visits; a minority also involved the use of brain scans and electroencephalography. A neurologist was consulted in about half the visits. Only electroencephalography and neurologic consultation contributed significantly to the final decision. Hospitalization was recommended in 71% of cases, but it was usually short term and not accompanied by significant changes in the management.
Conclusion:
In children with nonfebrile seizures, a problem-oriented approach including only the necessary work-up (e.g. electroencephalography) with neurologist consultation can potentially decrease the inpatient load and lower health care costs, while sparing patients unnecessary tests.
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