Yield of Neurodiagnostic Testing in Children Presenting to a Pediatric Emergency Department With Altered Mental
Camila Ospina Jimenez1, Lalitha Sivaswamy2, Giovanni Castellucci3
1Pediatric Emergency Fellow, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Neuroimaging and EEG studies in children with altered mental status (AMS) have low diagnostic yield. Most AMS cases in the emergency department are toxicologic, not neurologic, and often do not require advanced imaging.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Neurology
- Diagnostic Imaging
Background:
- Altered mental status (AMS) is a frequent reason for pediatric emergency department (ED) visits.
- The diagnostic utility of neuroimaging in pediatric AMS remains understudied.
- Understanding the yield of diagnostic tests is crucial for efficient patient management.
Purpose of the Study:
- To evaluate the diagnostic yield of neuroimaging studies in children presenting with AMS to the ED.
- To determine the contribution of neuroimaging and EEG to the etiologic diagnosis of pediatric AMS.
Main Methods:
- Retrospective chart review of 371 children (0-18 years) with AMS from 2018-2021.
- Analysis of neuroimaging and electroencephalogram (EEG) results, classifying abnormalities by clinical importance and contribution to diagnosis.
- Identification of the primary etiologies of AMS in the pediatric population.
Main Results:
- Toxicologic causes accounted for the majority (51%) of AMS cases, with neurologic causes being less common (13.5%).
- Neuroimaging was performed in 45.5% of patients, revealing abnormalities in 26%.
- Only 8.9% of neuroimaging studies were clinically important and contributed to the etiologic diagnosis; EEG had low diagnostic utility.
Conclusions:
- Neuroimaging contributes to the etiologic diagnosis in a minority of pediatric AMS cases.
- Electroencephalogram (EEG) also demonstrates limited diagnostic value in evaluating pediatric AMS.
- Findings suggest a need to refine diagnostic strategies for children presenting with altered mental status.
Background:
Emergency department (ED) visits for altered mental status (AMS) in children are common. Neuroimaging is often performed to ascertain etiology, but its utility has not been well studied. Our objective is to describe the yield of neuroimaging studies in children who present to an ED with AMS.
Methods:
We performed a retrospective chart review of children 0-18 years of age, presenting to our PED between 2018 and 2021 with AMS. We abstracted patient demographics, physical examination, neuroimaging and EEG results, and final diagnosis. Neuroimaging and EEG studies were classified as normal or abnormal. Abnormal studies were categorized as clinically important and contributory: abnormalities that were clinically important and contributed to the etiology, clinically important but noncontributory: abnormalities that were clinically significant but did not explain the etiology, and incidental: abnormalities that were not clinically significant.
Results:
We analyzed 371 patients. The most common etiology of AMS was toxicologic (188, 51%) with neurologic causes (n = 50, 13.5%) accounting for a minority. Neuroimaging was performed in one-half (169, 45.5%) and abnormalities were noted in 44 (26%) studies. Abnormalities were clinically important and contributed to the etiologic diagnosis of AMS in 15/169 (8.9%), clinically important and noncontributory in 18/169 (10.7%), and incidental in 11/169 (6.5%). EEG was performed in 65 patients (17.5%), of which 17 (26%) were abnormal with only one being clinically important and contributory.
Conclusions:
Though neuroimaging was performed in approximately one half of the cohort, it was contributory in a minority. Similarly, diagnostic utility of EEG in children with AMS was low.
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