PT  - JOURNAL ARTICLE
AU  - Mazzio, Emma
AU  - Mistry, Rakesh D.
AU  - Rosenthal, Scott
AU  - Ser, Eileen
AU  - Jewell, Jerry
AU  - Martin, Jan
AU  - Messer, Ricka
AU  - Straley, Megan
AU  - Leonard, Jan
AU  - Press, Craig A.
TI  - Neuroimaging for Pediatric Non–First-Time Seizures in the Emergency Department
AID  - 10.1212/CPJ.0000000000001165
DP  - 2022 Jun 01
TA  - Neurology: Clinical Practice
PG  - e7--e13
VI  - 12
IP  - 3
4099  - http://cp.neurology.org/content/12/3/e7.short
4100  - http://cp.neurology.org/content/12/3/e7.full
AB  - Background and Objectives Neuroimaging is often part of the workup for a pediatric patient presenting with a seizure to an emergency department (ED). We aim to evaluate when neuroimaging in the ED for children with a non–first-time seizure, or nonindex seizure (NIS), is associated with an acute change in management (ACM).Methods This is a retrospective cohort study of all pediatric patients presenting to an ED from 2008 to 2018 with a NIS, excluding repeat febrile seizures, who underwent neuroimaging. Clinical characteristics were extracted from the electronic medical record. The primary outcome was new abnormal neuroimaging resulting in an ACM, defined as admission to the hospital, neurosurgical intervention, or new nonseizure medication administration.Results We identified 492 encounters. Neuroimaging revealed new findings in 21% of encounters and led to ACMs in 5% of encounters. ACMs included admissions, neurosurgical interventions, and nonseizure medication changes. Factors associated with ACM included new seizure type (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.3–8.0), new focal examination finding (OR 3.0, 95% CI 1.3–7.1), altered mental status (OR 2.9, 95% CI 1.2–7.0), and a history of only provoked seizures (OR 2.8, 95% CI 1.0–7.5). Patients with 2 risk factors had an OR of 6.9 (95% CI 1.8–26.5) for an ACM, and those with 3–4 risk factors had an OR of 45.8 (95% CI 9.8–213.2). The negative predictive value for ACM in a patient with no risk factors was 98.6% (95% CI 95.9–99.5).Discussion Patients with a NIS who have abnormal neuroimaging associated with an ACM present with unique risk factors. Prospectively validating these factors may allow for a prediction tool for NIS in EDs where reduced exposure to ionizing radiation, sedation, and resource utilization are critically important.