Clinical assessment of children with first-attack seizures admitted to the ED

PurposeThis study aims to evaluate clinical values and determine the function of a pediatric observation unit (POU) as an alternative to inpatient unit admission for children with newly onset seizures.Basic ProceduresPediatric patients who were sent to the emergency department (ED) with new-onset seizure were retrospectively analyzed in a 6-year study period. All patients were divided into 3 groups: POU-discharged, unplanned inpatient admission, and required admission. Basic demographics, clinical course, biologic data, and radiologic findings were analyzed among the 3 groups.Main FindingsFrom the 910 children admitted to the ED with first attack of seizure, 405 (44.5%; mean age, 2.86 ± 2.64 years) were admitted to the POU. Of them, 184 (45.4%) were later discharged. Using multivariate logistic regression analysis, patients with febrile seizure, those without elevated serum C-reactive protein level, and those who did not require first-line anticonvulsants in the ED were associated with an increased trend of POU discharge.Principal ConclusionsThe POU may be an alternative to immediate admission in selected cases of first seizures. Related information such as age, use of anticonvulsants in the ED, serum C-reactive protein value, and clinical diagnosis of febrile seizure are important factors for determining whether pediatric patients with first seizure attack should be admitted or discharged.