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Investigations in children with seizures visiting a pediatric emergency department: A monocenter study
Johan Personnic1, Stéphane Auvin2, Luigi Titomanlio3
1APHP. Service de Neurologie Pédiatrique, Hôpital Robert-Debré, Paris, France; APHP, Service de Pédiatrique, Hôpital Ambroise-Paré, France; APHP. Service des urgences pédiatriques, Hôpital Robert-Debré, Paris, France.
Insights
Pediatric emergency departments see many seizures. Investigations for seizures in children with epilepsy may be overused, as many tests do not lead to a diagnosis or change management.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Investigations
Background:
- Seizures are a common reason for pediatric emergency department visits.
- Effective management of pediatric seizures requires appropriate diagnostic investigations.
Purpose of the Study:
- To determine the frequency of investigations for pediatric seizures.
- To evaluate the relevance and appropriateness of these investigations in the pediatric emergency department.
Main Methods:
- A one-year retrospective study of pediatric emergency department visits for epileptic events.
- Analysis of investigation appropriateness based on predefined criteria.
- Logistic regression to identify risk factors for acute symptomatic seizures (ASS).
Main Results:
- 691 epileptic events were identified out of 80,320 visits.
- Seizures in children with epilepsy accounted for 42% of cases.
- Investigations like blood electrolytes (26%), neuroimaging (9%), EEG (9%), and lumbar puncture (5%) were performed.
- Abnormal neurological examination was the sole significant risk factor for ASS (OR, 20.92).
- Seizures in epilepsy patients were linked to unprovoked seizures (OR, 0.12).
Conclusions:
- All acute symptomatic seizures were associated with abnormal examinations.
- A substantial number of investigations did not yield a diagnosis or alter patient management.
- Evidence suggests potential overuse of investigations for seizures in children with established epilepsy.
Aim:
Neurological disorders, in particular seizure, are one of the reasons for admission in pediatric emergency departments (PED). We aimed to evaluate the frequency and the relevance of each investigation for seizure management in the PED.
Methods:
We conducted a one-year retrospective study. Based on predefined criteria, we evaluate the appropriateness of the investigations. Logical regression was used to study the risk factors for acute symptomatic seizure (ASS).
Results:
We identified 691 visits to the PED for an epileptic event over an annual volume of 80,320 visits. Seizures occurring in Children with epilepsy were the most frequent epileptic events seen in the PED (42%). Looking at the investigation performed in the PED, a blood electrolytes analysis was performed in 26%, neuroimaging in 9%, electroencephalography recording in 9% and LP in 5% of patients. ASSs represented 2.1% of the seizures and 0.6% of PED neurological visits. In the multivariate analysis, an initial abnormal neurological examination (OR, 20.92 [4.87; 89.81, p<0.0001) was the only risk factor that remained significantly associated with ASS. A seizure occurring in an epilepsy patient was significantly associated with an unprovoked seizure (OR, 0.12 [0.02; 0.57], p<0.008).
Interpretation:
All ASSs were associated with a positive or abnormal examination. Moreover, there is a significant proportion of investigations requested in cases of an epileptic event that did not lead to a diagnosis or modification of the management. Based on our methods, there seems to be an overuse of investigations for seizure in children with epilepsy.
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