Prevalence and prediction of abnormal CT scan in pediatric patients presenting with a first seizure

To estimate the prevalence of abnormal neuroimaging in children presenting to the emergency department (ED) with a new-onset seizure, and to identify the significant clinical predictors for an abnormal CT scan.

In this cross-sectional study, all children age 12 or younger, admitted to the ED at King Abdulaziz Medical City (KAMC) in Riyadh, Kingdom of Saudi Arabia, between January 2005 and December 2010, with a first seizure clinically suspected of neurological condition, and a CT scan before discharge from the ED (N=124), were identified through a chart review. The charts for all patients with abnormal neuroimaging were reviewed for patient characteristics, seizure characteristics, and neuroimaging results. A logistic regression analysis was used to identify the independent predictors of an abnormal CT scan. Statistical significance was calculated at a p-value of ≤ = 0.05.

Abnormal CT results were found in 53/124 patients (42.7%). These were significantly associated with the presence of a lesional CNS disorder (x² =16.1, p<0.01), developmental delays (Fisher exact test, p<0.01), generalized seizure (x² =4.17, p=0.04), and the presence of new focal neurological findings (x² = 21.70, p<0.01). However, after applying a logistic regression analysis to adjust for different confounders, only developmental delay (odds ratio [OR]=4.79, p=0.01) and focal neurological findings (OR=7.85, p=0.006) significantly predicted an abnormal CT scan.

This study demonstrates a high prevalence of abnormalities identified on the CT scans of children who presented with their first apparent seizure. An emergency CT may be considered in children presenting with their first seizure.