New-onset seizures in pediatric emergency.
BACKGROUND
Seizures account for 1% of all pediatric emergency department (ED) visits. The aim of this study was to analyze the clinical spectrum and prevalence rates of various etiologies in children with a first attack of acute seizure disorder in the ED.


METHODS
We evaluated 319 children who presented to the ED at the Changhua Children's Hospital with a first attack of seizure disorder from 2005 to 2007. Variables including demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnoses and hospital course were compared between patients with seizures and fever, and patients with seizures without fever. These variables were also compared between patients with simple and complex febrile seizures and among different age groups.


RESULTS
Among these 319 patients, 218 (68%) presented with seizures and fever and 299 (94%) children were younger than 6 years of age. Generalized tonic-clonic seizures were the most common type (71.2%). Febrile seizures (62.1%) were the main etiology of the first seizure (p < 0.001). Seizures caused by severe electrolyte imbalance or hypoglycemia were noted in three patients. Abnormal brain images were noted in 16 (26%) of 61 patients, most (12/16, 75%) of whom had abnormal histories and physical or neurologic examinations.


CONCLUSIONS
Primary care pediatricians should evaluate children presenting to the ED with a first seizure for age, coexistence of fever, seizure type, associated symptoms and history of head injury. We suggest that electrolytes, blood sugar and emergent brain imaging studies should be arranged based on detailed history-taking and thorough physical examinations, but should not be performed routinely.
Chen
Chun-Yu
CY
Division of Pediatric Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan. arthur1226@gmail.com
Chang
Yu-Jun
YJ
Wu
Han-Ping
HP
D000293:Adolescent; D001569:Benzodiazepines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology*; D003294:Seizures, Febrile / Q000175:diagnosis / Q000453:epidemiology
D001569:Benzodiazepines