Etiologies and Yield of Diagnostic Testing in Children Presenting to the Emergency Department with Altered Mental Status

Button, Katharine; Capraro, Andrew; Monuteaux, Michael C.; Mannix, Rebekah

doi:10.1016/j.jpeds.2018.04.037

Cited by 8 publications

(9 citation statements)

References 41 publications

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“…Our last prediction of the four red-flags predictors, alteration of the mental status, had the lowest odds ratio. This is concordant with the clinical situation that other extracranial causes, such as sepsis, hypovolemia, and electrolyte imbalance, may also induce mental status changes in children [ 26 ].…”

Section: Discussionsupporting

confidence: 73%

Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches

et al. 2022

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Introduction: Diagnosis of emergent intracranial lesions that require emergency treatment either medically or surgically in non-traumatic pediatric headaches is important. Red-flag signs and symptoms are commonly used as justification for neuroimaging; however, evidence on its diagnostic values is limited. The study aims to identify diagnostic values of red-flags and develop a clinical prediction score to help improve the diagnostic yield of neuroimaging. Methods: A retrospective review of 109 pediatric patients from 2006 to 2020 who presented with a non-traumatic headache was conducted. A clinical prediction score from red flags was developed using multivariate logistic regression. Discriminatory ability was examined using the area under the receiver operating characteristic curve. Results: A total of 51 patients were diagnosed with emergent intracranial lesions. Four potential clinical red flag predictors were identified: (1) acute onset (less than 3 months), (2) altered conscious state, (3) focal motor abnormality, and (4) and ocular/pupillary abnormality or squint. A clinical prediction score was developed with good discriminatory properties (0.84). Conclusions: Clinical predictor scores from these four red flags may play an important role in maximizing neuroimaging and proper management for pediatric patients with non-traumatic headaches. Future validation studies are needed and could guide referrals and optimize the use of neuroimaging for these patients.

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Section: Discussionsupporting

confidence: 73%

Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches

et al. 2022

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“…Etiologies of altered mental status in children varied widely including vascular, toxin-mediated, infectious, metabolic, and traumatic causes and often an underlying diagnosis was not found. It has been reported that the most common cause of etiology in children under the age of 12 is neurological, and the most common cause in children older than 12 years is toxicological (11). In this study, the reason for seeking consultation in 2.1% was the acute altered mental status.…”

Section: Discussionmentioning

confidence: 71%

Outcomes of Inpatient Child Neurology Consultations

Ekici¹,

Havalı²,

BALDAN

et al. 2021

Osmangazi̇ Journal of Medicine

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Child neurology covers a wide range of relevant topics. Both doctors and parents are concerned when a child complains of being unable to walk or having a headache, and they are afraid of postponing the diagnosis. The goal of this study was to assess pediatric neurology inpatient consults. A total of 1,669 requests for pediatric neurology inpatient consultations were reviewed retrospectively during a one-year period. Seizure and febrile seizure were the most common reasons for child neurology consultations (60,6% and 12.2%, respectively). Neuromotor developmental delay (5.7%), syncope (3.4%), headache (2.6%), altered mental status (2.1%), acute complaint of inability to walk (1.8%), facial nerve paralysis (1.4%), ataxia (1.2%), and monoparesis/hemiparesis (1.2%) were among the other reasons for child neurology consultations (1%). Fifty-seven patients (8.8%) who were consulted owing to a seizure were not diagnosed as having seizures. The most common cause of changed mental status was meningoencephalitis. Nine (47.4%) of the patients with acute inability to walk were evaluated as viral myositis. In a patient with acute neurological symptoms, there may be a simple underlying cause or a serious cause.

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“…AMS in children represents a diagnostic challenge, mainly because it encompasses a wide spectrum of disease with different underlying etiologies. Among them are complex migraines, seizures and encephalitis; this wide spectrum is one of the reasons for which the literature is unclear on the most useful test to help determine the specific etiology of AAMS in the pediatric population (6). A recent study of a large cohort of children with AMS revealed that only 114/336 patients received a definite diagnosis in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded 37 studies that did not meet inclusion criteria. Ultimately, we focused on 16 articles, which we categorized into two groups, adults and children, as detailed in Table 1 (6,10,(19)(20)(21)(22)(23)(24)(11)(12)(13)(14)(15)(16)(17)(18). Most of the selected studies reported data on EEG monitoring during symptomatic episodes, although one study did not report EEG results (12)and another did not use EEG at all (6).…”

Section: Literature Reviewmentioning

confidence: 99%

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The Role of Electroencephalography in Children with Acute Altered Mental Status of Unknown Etiology: A Prospective Study

Chiarello,

Perrone,

Ricci

et al. 2024

Neuropediatrics

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Introduction: Acute alterated mental status (AAMS) is often a challenge for clinicians, since the underlying etiologies cannot always easily be inferred based on the patient’s clinical presentation, medical history or early examinations. The aim of this study is to evaluate the role of the electroencephalogram (EEG) as a diagnostic tool in AAMS of unknown etiology in children. Materials and Methods. We conducted a prospective study involving EEG assessments on children presenting with AAMS between May 2017 and October 2019. Inclusion criteria were age 1 month to 18 years and acute (<1 week) and persistent (>5 minutes) Altered mental status (AMS). Patients with a known etiology of AAMS were excluded. A literature review was also performed. Results. Twenty patients (median age: 7.7 years, range: 0.5-15.4) were enrolled. EEG contributed to the diagnosis in 14/20 cases, and was classified as diagnostic in 9/20 and informative in 5/20. Specifically, EEG was able to identify nonconvulsive status epilepticus (NCSE) in 5 children and psychogenic events in 4. EEG proved to be a poorly informative diagnostic tool at AAMS onset in 6 children, however in 5 of them, it proved useful during follow-up. Conclusions. Limited data exist regarding the role of EEG in children with AAMS of unknown etiology. In our population EEG proved to be valuable tool, and was especially useful in the prompt identification of NCSE and psychogenic events.

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Etiologies and Yield of Diagnostic Testing in Children Presenting to the Emergency Department with Altered Mental Status

Abstract: Etiologies of altered mental status in children varied widely and often an underlying diagnosis was not found. Broad diagnostic testing was commonly performed although the overall yield was low.

Cited by 8 publications

References 41 publications

Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches

Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches

Outcomes of Inpatient Child Neurology Consultations

The Role of Electroencephalography in Children with Acute Altered Mental Status of Unknown Etiology: A Prospective Study

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