Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

Dayan, Peter; Lillis, Kathleen; Bennett, Jonathan E.; Conners, Gregory P.; Bailey, P.W.; Callahan, James M.; Akman, Cigdem I.; Feldstein, Neil A.; Kriger, Joshua; Hauser, W. Allen; Kuppermann, Nathan

doi:10.1542/peds.2014-3550

Cited by 22 publications

(22 citation statements)

References 22 publications

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“…This study however only included 11% of patients with seizure > 15 minutes, and seizure duration > 15 minutes was associated with an increased incidence of abnormal neuroimaging findings. 24 Our data add and expand to the previously reported yield of neuroimaging; in this cohort of children with new-onset seizure and status epilepticus we found of 36% of children with abnormal neuroimaging of which 8.5% had pathology requiring urgent or emergent interventions.…”

Section: Discussionsupporting

confidence: 81%

Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus

Lyons

Johnson

Michelson

et al. 2016

Seizure

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PURPOSE To determine the yield of emergent neuroimaging among children with new-onset seizures presenting with status epilepticus. METHOD We performed a cross-sectional study of children seen at a single ED between 1995–2012 with new-onset seizure presenting with status epilepticus. We defined status epilepticus as a single seizure or multiple seizures without regaining consciousness lasting 30 minutes or longer. Our primary outcome was urgent or emergent intracranial pathology identified on neuroimaging. We categorized neuroimaging results as emergent if they would have changed acute management as assessed by a blinded neuroradiologist and neurologist. To ensure abnormalities were not missed, we review neuroimaging results for 30 days following the initial episode of SE. RESULTS We included 177 children presenting with new-onset seizure with status epilepticus, of whom 170 (96%) had neuroimaging performed. Abnormal findings were identified on neuroimaging in 64/177 (36%, 95% confidence interval 29–43%) children with 15 (8.5%, 95% confidence interval 5.2–14%) children having urgent or emergent pathology. Four (27%) of the 15 children with urgent or emergent findings had a normal non-contrast computed tomography scan and a subsequently abnormal magnetic resonance image. Longer seizure duration and older age were associated with urgent or emergent intracranial pathology. CONCLUSION A substantial minority of children with new-onset seizures presenting with status epilepticus have urgent or emergent intracranial pathology identified on neuroimaging. Clinicians should strongly consider emergent neuroimaging in these children. Magnetic resonance imaging is the preferred imaging modality when available and safe.

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Section: Discussionsupporting

confidence: 81%

Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus

Lyons

Johnson

Michelson

et al. 2016

Seizure

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“…We enrolled 475 of 625 (76.0%) eligible children (comparisons between those who were and not enrolled are detailed in parent manuscript) . Of the 475 patients, we excluded 27 patients from all analyses for the following reasons: a clear precipitant was present ( n = 12), the event was not a seizure based on follow‐up telephone call ( n = 9), or the seizure was either an absence seizure or a prevalent (not incident) seizure ( n = 6).…”

Section: Resultsmentioning

confidence: 99%

“…We performed a secondary analysis of data from a prospective cohort study of children who presented with seemingly unprovoked seizures to any of six urban, university‐affiliated pediatric EDs in the US between March 2005 and September 2007. The parent study assessed the risk of intracranial abnormalities in children with first unprovoked seizures . Each center's institutional review board approved the study.…”

Section: Methodsmentioning

confidence: 99%

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Early Recurrence of First Unprovoked Seizures in Children

Goldberg

Kernie

Lillis

et al. 2017

Academic Emergency Medicine

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“…Previous studies of interrater agreement have focused on physician-physician or physician-nurse dyads. [26][27][28] We demonstrated that the overall percentage agreement was high for all modified Centor score predictors between the clinician and patient or parent. When we evaluated the κ, however, which measures agreement beyond chance alone, the agreement for historical symptoms was moderate or high and lower for clinical examination findings.…”

Section: Figurementioning

confidence: 99%

Patient and Parent-Reported Signs and Symptoms for Group A Streptococcal Pharyngitis

Lindgren¹,

Neuman

Monuteaux

et al. 2016

Pediatrics

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BACKGROUND AND OBJECTIVES: Identifying symptomatic patients who are at low risk for group A streptococcal (GAS) pharyngitis could reduce unnecessary visits and antibiotic use. The accuracy with which patients and parents report signs and symptoms of GAS has not been studied. Our objectives were to measure agreement between patient or parent and physician-reported signs and symptoms of GAS and to evaluate the performance of a modified Centor score, based on patient or parent and physician reports, for identifying patients at low risk for GAS pharyngitis.

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Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

Cited by 22 publications

References 22 publications

Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus

Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus

Early Recurrence of First Unprovoked Seizures in Children

Patient and Parent-Reported Signs and Symptoms for Group A Streptococcal Pharyngitis

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