Authors :
Maria El-Hallal, Cohen Children's Medical Center; Yash Shah - Cohen Children's Medical Center; Padmavati Eksambe - Cohen Children's Medical Center; Manan Nath - Cohen Children's Medical Center; Robin Varughese - Cohen Children's Medical Center; Liana Ther
Rationale:
Seizures and seizure-like activity comprise 1% of all visits to the pediatric Emergency Department (ED). There is no clear consensus on the evaluation and management of pediatric patients presenting to the ED with seizures. Guidelines on laboratory testing, neuroimaging, and encephalography are not based on strong evidence. Given the complicated and multi-step work up of seizures, patients often undergo unnecessary testing that leads to prolonged ED visits4. Lower ED length of stay has been linked to improved patient experience and may reduce ED overcrowding.
Method:
This is a retrospective cohort study involving patient records over the period of 6 months at an urban tertiary children’s hospital. Patient records were searched within a period of 6 months for all patients less than 18 years of age with a primary or secondary diagnosis of seizure. Excluded were febrile seizures, seizures associated with trauma, and charts of patients who did not present initially through our ED. A total of 328 charts were obtained through this search criteria.
Continuous data are presented as mean ± SD and categorical data are presented as frequencies and percentiles. Univariate analyses between two groups for categorical data were performed by the Χ2 test and for continuous data were performed by the Mann-Whitney U test. Linear regression was performed to determine factors on ED length of stay. A one-sided p value of < 0.05 was considered significant. Results328 patients presented to the ED for seizures or seizure-like activity in the 6 months of data collection. 143 patients (44%) presented with their first episode of seizure-like activity while the remaining 185 (56%) were established patients.
Head-imaging was performed in 54 (16%) patients. CT comprised 78% (n=42) of head imaging with 22% MR imaging (n=12). Obtaining any kind of imaging prolonged ED stay by 2.1hrs (7.0hrs vs 4.9hrs; p< 0.05) Figure 1. Using a linear regression model, visits where an MRI was obtained were 2.69 hours longer than visits where no MRI was done (p= 0.07). Visits where a CT was obtained were 1.92 hours longer than visits where no CT was done (p< 0.05).
Of the 328 patient visits in ED, EEG was obtained for 67 (20%) visits. The average ED length of stay for patients receiving EEG was 7.1 hours (SD = 2.5) compared to 4.1 hours (SD = 10) if no EEG was performed. Using linear regression, ED visits in which an EEG was performed were 2.9 hours longer than ED visits where EEG was not done (p < 0.001).
Conclusion:
Obtaining neurodiagnostic studies significantly prolongs duration of stay in the ED. Physicians should have a strong logical basis for obtaining studies and must follow national guidelines where applicable.
Funding:
:None.
FIGURES
Figure 1