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Predictors of Clinically Important Neuroimaging Findings in Children Presenting Pediatric Emergency Department
Emre Gungor1, Goknur Haliloglu2, Dilek Yalnizoglu2
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics.
Insights
Certain symptoms like blurred vision, ataxia, unilateral weakness, and altered consciousness predict important neuroimaging results in children. This helps guide appropriate advanced neuroimaging in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Neuroradiology
- Clinical Neurology
Background:
- Advanced neuroimaging, including computed tomography (CT) and magnetic resonance imaging (MRI), is frequently utilized in pediatric emergency departments (PEDs).
- Identifying predictors of clinically important neuroimaging findings is crucial for optimizing diagnostic pathways and resource allocation.
- Unnecessary neuroimaging may lead to diagnostic delays and increased healthcare costs.
Purpose of the Study:
- To evaluate predictors of clinically important neuroimaging results in children presenting to an academic pediatric emergency department.
- To determine the association between specific clinical symptoms and the likelihood of significant findings on neuroimaging.
Main Methods:
- Retrospective analysis of demographic and clinical data from pediatric emergency department visits between 2015 and 2019.
- Inclusion of neuroimaging findings requested during these visits.
- Descriptive statistics and logistic regression analyses were employed to identify predictors.
Main Results:
- Clinically important neuroimaging findings were significantly associated with blurred vision (P = 0.001), ataxia (P = 0.003), unilateral weakness (P = 0.004), and altered level of consciousness (P = 0.026).
- Patients with altered level of consciousness had 9.4 times higher odds of clinically important findings.
- Focal weakness, blurred vision, and ataxia were also strong predictors, with odds ratios of 7.4, 4.6, and 3.5, respectively.
Conclusions:
- Selected pediatric patients in the emergency department benefit from advanced neuroimaging, improving healthcare quality.
- Symptoms such as ataxia, blurred vision, altered consciousness, and unilateral weakness are key indicators for considering neuroimaging.
- Targeted neuroimaging can facilitate early diagnosis and treatment, while avoiding unnecessary scans improves clinical focus.
Objective:
The aim of the study is to evaluate predictors of clinically important neuroimaging results, that is, computed tomography and magnetic resonance imaging in children in an academic pediatric emergency department (PED) from 2015 to 2019.
Methods:
This study was conducted in an academic PED. The patient's demographic and clinical characteristics of PED visits and neuroimaging findings requested at the PED were recorded for January 1, 2015, to December 31, 2019. In addition, descriptive statistics and logistic regression analyses were conducted. We described and determined the predictors of clinically important neuroimaging findings in children.
Results:
Clinically important neuroimaging findings were detected in patients with blurred vision ( P = 0.001), ataxia ( P = 0.003), unilateral weakness ( P = 0.004), and altered level of consciousness ( P = 0.026). Clinically important neuroimaging was found 9.4 times higher in patients with altered level of consciousness, 7.4 times higher in patients with focal weakness, 4.6 times higher in patients with blurred vision, and 3.5 times more in patients presenting with ataxia.
Conclusions:
Advanced neuroimaging, especially for selected patients in PED, can improve the quality of health care for patients. On the other hand, irrelevant neuroimaging findings can lead physicians away from prompt diagnosis and accurate management. According to our study, advanced neuroimaging can be performed in the early period for both diagnosis and early treatment, especially in selected patients with ataxia, blurred vision, altered consciousness, and unilateral weakness. In other cases, clinicians may find more supporting evidence.
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