Use of Neuroimaging for Children With Seizure in General and Pediatric Emergency Departments

J Emerg Med. 2021 Apr;60(4):478-484. doi: 10.1016/j.jemermed.2020.10.044. Epub 2021 Jan 5.


Background: Seizure is a common reason for children to visit the emergency department (ED). Pediatric and general EDs may obtain computed tomography (CT) scans of the head for seizure at different rates.

Objective: To compare rates of head CT for pediatric seizure between general and pediatric EDs.

Methods: This was a retrospective cohort study using the National Hospital Ambulatory Medical Care Survey for patients <21 years of age presenting to an ED with a chief complaint or diagnosis of seizure between 2006 to 2017. Of these patients, we compared head CT use between general and pediatric EDs among patients with fever, trauma, and co-diagnosis of epilepsy using univariable risk differences and in a multivariable logistic regression model.

Results: More than 5 (5.4) million (78.8%) and 1.5 million (21.2%) pediatric patients with seizure presented to general and pediatric EDs, respectively. Of those, 22.4% (1.21 million) and 13.2% (192,357) underwent CT scans of the head, respectively, a risk difference of 9.2% (95% confidence interval [CI] 2.3-16.1). General EDs obtained CT scans of the head more often in patients with epilepsy (risk difference 17.9% [95% CI 4.0-31.9]), without fever (12.2% [95% CI 3.1-21.4]), and without trauma (10.6% [95% CI 4.4-16.8]). Presenting to a general ED, being afebrile, or having trauma were associated with head CT with adjusted odds ratios of 1.7 (95% CI 1.0-3.2), 4.9 (95% CI 2.6-9.2), and 2.0 (95% CI 1.2-3.4), respectively. Age, gender, and epilepsy were not associated with head CT among all patients with seizure.

Conclusions: Children with seizure are more likely to undergo CT scans of the head at general EDs compared with pediatric EDs.

Keywords: neuroimaging; pediatric emergencies; quality; seizure.

MeSH terms

  • Child
  • Emergency Service, Hospital*
  • Health Care Surveys
  • Humans
  • Infant
  • Neuroimaging*
  • Retrospective Studies
  • Seizures