title: Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures.
abstract: OBJECTIVE
  Prospective data are lacking to determine which children might benefit from prompt neuroimaging after unprovoked seizures. We aimed to determine the prevalence of, and risk factors for, relevant intracranial abnormalities in children with first, unprovoked seizures.
  
  
  METHODS
  We conducted a 6-center prospective study in children aged >28 days to 18 years with seemingly unprovoked seizures. Emergency department (ED) clinicians documented clinical findings on a standardized form. Our main outcome was the presence of a clinically relevant intracranial abnormality on computed tomography (CT) or MRI, defined as those that might change management, either emergently, urgently, or nonurgently.
  
  
  RESULTS
  We enrolled 475 of 625 (76%) eligible patients. Of 354 patients for whom cranial MRI or CT scans were obtained in the ED or within 4 months of the ED visit, 40 (11.3%; 95% confidence interval [CI]: 8.0-14.6%) had clinically relevant intracranial abnormalities, with 3 (0.8%; 95% CI: 0.1-1.8%) having emergent/urgent abnormalities. On logistic regression analysis, a high-risk past medical history (adjusted odds ratio: 9.2; 95% CI: 2.4-35.7) and any focal aspect to the seizure (odds ratio: 2.5; 95% CI: 1.2-5.3) were independently associated with clinically relevant abnormalities.
  
  
  CONCLUSIONS
  Clinically relevant intracranial abnormalities occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most children do not require neuroimaging in the ED. Findings on patient history and physical examination identify patients at higher risk of relevant abnormalities.
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; psd6@columbia.edu.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York;
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lillis
authors.affiliation: Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware;
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bennett
authors.affiliation: Department of Emergency Medicine, University of Rochester, Rochester, New York;
authors.forename: Gregory
authors.initials: G
authors.lastname: Conners
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
authors.forename: Pam
authors.initials: P
authors.lastname: Bailey
authors.affiliation: Departments of Emergency Medicine and Pediatrics, Upstate Medical College, Syracuse, New York;
authors.forename: James
authors.initials: J
authors.lastname: Callahan
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York;
authors.forename: Cigdem
authors.initials: C
authors.lastname: Akman
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York;
authors.forename: Neil
authors.initials: N
authors.lastname: Feldstein
authors.affiliation: Department of Biostatistics, Columbia University Medical Center, New York, New York;
authors.forename: Joshua
authors.initials: J
authors.lastname: Kriger
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; Gertrude Sergievsky Center, New York, New York; and.
authors.forename: W Allen
authors.initials: WA
authors.lastname: Hauser
authors.affiliation: Departments of Emergency Medicine and Pediatrics, Davis School of Medicine, University of California, Sacramento, California.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001921:Brain / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed