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Investigations in children with seizures visiting a pediatric emergency department: A monocenter study

  • Johan Personnic
    Affiliations
    APHP. 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
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  • Stéphane Auvin
    Affiliations
    APHP. Service de Neurologie Pédiatrique, Hôpital Robert-Debré, Paris, France

    Université de Paris, INSERM NeuroDiderot, Paris, France

    Institut Universitaire de France (IUF), Paris, France
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  • Luigi Titomanlio
    Affiliations
    Université de Paris, INSERM NeuroDiderot, Paris, France

    APHP. Service des urgences pédiatriques, Hôpital Robert-Debré, Paris, France
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  • Blandine Dozières-Puyravel
    Correspondence
    Corresponding author. Service de Neurologie Pédiatrique, CHU Hôpital Robert Debré 48, boulevard Sérurier, 75935, PARIS CEDEX 19, France.
    Affiliations
    APHP. Service de Neurologie Pédiatrique, Hôpital Robert-Debré, Paris, France
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      Highlights

      • Seizures occurring in Children with epilepsy are the most frequent epileptic events seen in the emergency room.
      • Acute symptomatic seizure represents 2.1% of the seizures seen at the emergency room.
      • In children, two-thirds of acute symptomatic seizure are related to infectious causes.
      • A positive history or an abnormal examination were observed in all children with acute symptomatic seizure in our study.

      Abstract

      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.

      Keywords

      Abbreviations:

      AAN (American Academy of Neurology), ASS (acute symptomatic seizure), CSF (cerebrospinal fluid), EEG (electroencephalogram), LP (lumbar puncture), PED (pediatric emergency department)
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