title: The Yield of Neuroimaging in Children Presenting to the Emergency Department With Acute Ataxia in the Post-Varicella Vaccine Era.
abstract: To determine the yield of neuroimaging in children presenting to the emergency department with acute ataxia in the post-varicella vaccine era, we conducted a cross-sectional study between 1995 and 2013 at a single pediatric tertiary care center. We included children aged 1-18 years evaluated for acute ataxia of <7 days' duration. The main outcome was clinically urgent intracranial pathology defined as a radiologic finding that changed initial management. We identified 364 children, among whom neuroimaging was obtained in 284 (78%). Forty-two children had clinically urgent intracranial pathology (13%, 95% confidence interval 9%-17%); tumors and acute disseminated encephalomyelitis were the leading findings. Age ≤3 years and symptoms ≤3 days of duration were predictors of low risk (0.7%, 95% confidence interval 0%-4.4%). In conclusion, neuroimaging may be indicated for most patients presenting with acute ataxia. Neuroimaging may be deferred in younger children with short duration of symptoms contingent on close follow-up.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Rudloe
authors.affiliation: Neuroradiology, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Prabhu
authors.affiliation: Neurology, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Gorman
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA Infectious Diseases, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Marvin B
authors.initials: MB
authors.lastname: Harper
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Assaf
authors.initials: A
authors.lastname: Landschaft
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA amir.kimia@childrens.harvard.edu.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Kimia
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D000553:Ambulatory Care; D001259:Ataxia / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D001921:Brain / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D059906:Neuroimaging; D012306:Risk; D013997:Time Factors
keywords: ataxia; emergency department; imaging