title: Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus.
abstract: OBJECTIVE
  To determine the yield of emergent neuroimaging among children with new-onset seizures presenting with status epilepticus.
  
  
  METHODS
  We performed a cross-sectional study of children seen at a single ED between 1995 and 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 min 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: Todd.Lyons@childrens.harvard.edu.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Lyons
authors.affiliation: Duke University Hospital, Duke University School of Medicine, Durham, NC, United States. Electronic address: kara.johnson@dm.duke.edu.
authors.forename: Kara B
authors.initials: KB
authors.lastname: Johnson
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: Kenneth.Michelson@childrens.harvard.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Michelson
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: Lise.Nigrovic@childrens.harvard.edu.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: Tobias.Loddenkemper@childrens.harvard.edu.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: Sanjay.Prabhu@childrens.harvard.edu.
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Prabhu
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: Amir.Kimia@childrens.harvard.edu.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Kimia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D012640:Seizures / Q000175:diagnosis*; D018709:Statistics, Nonparametric; D013226:Status Epilepticus / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Children; Neuroimaging; Seizure; Status epilepticus