title: The role of emergent neuroimaging in children with new-onset afebrile seizures.
abstract: OBJECTIVE
  The objectives of this study were 1) to determine the frequency of clinically significant abnormal neuroimaging in children coming to the emergency department (ED) with new-onset afebrile seizures (ASZ), and 2) to identify children at high or low risk for clinically significant abnormal neuroimaging.
  
  
  METHODS
  Five hundred consecutive cases of new-onset ASZ seen in the ED of a tertiary care children's hospital were reviewed. Neuroimaging reports were categorized as normal, clinically insignificant abnormal, or clinically significant abnormal. Recursive partition analysis was used to identify clinical variables that separated children into high- and low-risk groups for clinically significant abnormal neuroimaging.
  
  
  RESULTS
  Ninety-five percent of patients (475/500) with new-onset ASZ had neuroimaging. Clinically significant abnormal neuroimaging was noted in 8% (95% confidence interval [CI]: 6, 11; 38/475) of patients. Recursive partition analysis identified 2 criteria associated with high risk for clinically significant abnormal neuroimaging: 1) the presence of a predisposing condition, and 2) focal seizure if <33 months old. Of the high-risk patients, 26% (95% CI: 17, 35; 32/121) had clinically significant abnormal neuroimaging compared with 2% (95% CI: 0.6, 3.7; 6/354) in the low-risk group.
  
  
  CONCLUSIONS
  In this large, retrospective review of children with new-onset ASZ, clinically significant abnormal neuroimaging occurred with relatively low frequency. Emergent neuroimaging should be considered, however, for children who meet high-risk criteria. Well-appearing children who meet low-risk criteria can be safely discharged from the ED (if follow-up can be assured) without emergent neuroimaging, because their risk for clinically significant abnormal neuroimaging is appreciably lower.
authors.affiliation: Department of Emergency Medicine, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia 30342, USA. sujits@pol.net
authors.forename: Sujit
authors.initials: S
authors.lastname: Sharma
authors.forename: James J
authors.initials: JJ
authors.lastname: Riviello
authors.forename: Marvin B
authors.initials: MB
authors.lastname: Harper
authors.forename: Marc N
authors.initials: MN
authors.lastname: Baskin
mesh_terms: D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed