Emergent diagnostic testing for pediatric nonfebrile seizures

BackgroundGuidelines from the American Academy of Neurology recommend laboratory studies or computed tomography (CT) for children who experience a nonfebrile seizure if anything in their history suggests a clinically significant abnormality.ObjectiveTo ascertain if any patient or seizure characteristics are associated with a greater likelihood that laboratory studies or CT scan will yield clinically significant results.MethodsThis retrospective case series reviewed 93 children with nonfebrile seizure, who were evaluated in an urban pediatric emergency department (ED) between July 2007 and June 2011.ResultsLaboratory studies were performed in 87% of the study group; 7% of those tests gave clinically significant results. Computed tomographic scans were obtained in 35% of our patients; 9% showed clinically significant findings. Presence of an active seizure in the ED or a first nonfebrile seizure had an 8% and 11% difference, respectively, for clinically significant laboratory abnormality. Children younger than 2 years showed a 7% difference of clinically significant laboratory abnormality.ConclusionThis study did not identify statistically significant predictors of laboratory or CT abnormalities for children with nonfebrile seizure presenting to the ED. Age less than 2 years, having an active seizure in the ED, and experiencing a first-time seizure showed a trend toward an increased yield of laboratory testing. In accordance with the American Academy of Neurology guidelines, we conclude that the history of a child's present illness preceding the nonfebrile seizure, not characteristics of the seizure, should be used to determine the need for further testing.