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

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

Sarah C Cavallaro  1 , Michael C Monuteaux  1 , Pradip P Chaudhari  2 , Kenneth A Michelson  1
Affiliations

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

Sarah C Cavallaro et al. J Emerg Med. 2021 Apr.

Abstract

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.

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Conflict of interest statement

Conflict of Interests: We do not have any conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Rate of Head CT in Subgroups Pediatric Patients by ED Type This table shows the rate of head CT in pediatric patients presenting to both general and pediatric EDs by patient characteristics.
See this image and copyright information in PMC

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