N Aprahamian1, M B Harper2, S P Prabhu3, M C Monuteaux4, Z Sadiq5, A Torres6, A A Kimia7. 1. Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Nadine.aprahamian@childrens.harvard.edu. 2. Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Marvin.Harper@childrens.harvard.edu. 3. Boston Children's Hospital, Department of Neurology, Neuro-Radiology Unit, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Sanjay.prabhu@childrens.harvard.edu. 4. Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: michael.monuteaux@childrens.harvard.edu. 5. Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Zujajas@hotmail.com. 6. Boston Medical Center, Department of Neurology, One Boston Medical Center Place, Boston, MA 02118, United States. Electronic address: Alcy.Torres@bmc.org. 7. Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: amir.kimia@childrens.harvard.edu.
Abstract
PURPOSE: To assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-febrile seizure with focal manifestations. METHODS: We performed a cross sectional study of all children age 1 month to 18 years evaluated for first episode of non-febrile seizure with focal manifestations and having neuroimaging performed within 24h of presentation at a single pediatric ED between 1995 and 2012. We excluded intubated patients, those with known structural brain abnormality and trauma. A single neuro-radiologist reviewed all cranial computed tomography and/or magnetic resonance imaging performed. We defined clinically urgent intracranial pathology as any finding resulting in a change of initial patient management. We performed univariate analysis using χ(2) analysis for categorical data and Mann-Whitney U test for continuous data. RESULTS: We identified 319 patients having a median age of 4.6 years [IQR 1.8-9.4] of which 45% were female. Two hundred sixty-two children had a CT scan, 15 had an MR and 42 had both. Clinically urgent intra-cranial pathology was identified on imaging of 13 patients (4.1%; 95% CI: 2.2, 7.0). Infarction, hemorrhage and thrombosis were most common (9/13). Twelve of 13 were evident on CT scan. Persistent Todd's paresis and age ≤ 18 months were predictors of clinically urgent intracranial pathology. Absence of secondary generalization and multiple seizures on presentation were not predictive. CONCLUSIONS: Four percent of children imaged with first time, afebrile focal seizures have findings important to initial management. Children younger than ≤ 18 months are at increased risk.
PURPOSE: To assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-febrile seizure with focal manifestations. METHODS: We performed a cross sectional study of all children age 1 month to 18 years evaluated for first episode of non-febrile seizure with focal manifestations and having neuroimaging performed within 24h of presentation at a single pediatric ED between 1995 and 2012. We excluded intubated patients, those with known structural brain abnormality and trauma. A single neuro-radiologist reviewed all cranial computed tomography and/or magnetic resonance imaging performed. We defined clinically urgent intracranial pathology as any finding resulting in a change of initial patient management. We performed univariate analysis using χ(2) analysis for categorical data and Mann-Whitney U test for continuous data. RESULTS: We identified 319 patients having a median age of 4.6 years [IQR 1.8-9.4] of which 45% were female. Two hundred sixty-two children had a CT scan, 15 had an MR and 42 had both. Clinically urgent intra-cranial pathology was identified on imaging of 13 patients (4.1%; 95% CI: 2.2, 7.0). Infarction, hemorrhage and thrombosis were most common (9/13). Twelve of 13 were evident on CT scan. Persistent Todd's paresis and age ≤ 18 months were predictors of clinically urgent intracranial pathology. Absence of secondary generalization and multiple seizures on presentation were not predictive. CONCLUSIONS: Four percent of children imaged with first time, afebrile focal seizures have findings important to initial management. Children younger than ≤ 18 months are at increased risk.
Authors: Peter S Dayan; Kathleen Lillis; Jonathan Bennett; Gregory Conners; Pam Bailey; James Callahan; Cigdem Akman; Neil Feldstein; Joshua Kriger; W Allen Hauser; Nathan Kuppermann Journal: Pediatrics Date: 2015-07-20 Impact factor: 7.124