Allen Leslie, Jones Charlotte T
Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA.
J Child Neurol. 2007 Sep;22(9):1099-101. doi: 10.1177/0883073807306249.
Children with epilepsy are frequently evaluated in the emergency department for breakthrough seizure activity. This population is at risk for undergoing repeated computed tomography (CT) scans. The long-term health risks associated with CT scans has been the subject of multiple articles in recent years. In 2002, the National Cancer Institute released a statement that focused on reducing long-term health risks by limiting children's exposure to CT radiation. A retrospective study that included 124 children (ages 2 months-16 years) who presented to our emergency department with epilepsy and breakthrough seizure activity was performed to determine whether the National Cancer Institute statement made an impact on the number of head CT scans ordered. Physician's compliance with the American Academy of Neurology guidelines for emergent head CT scans in patients with known seizure disorder and the diagnostic yield of the head CT scans was also assessed. There was a significant increase (P = .016) in the number of CT scans performed from the years 2000-2001 to the years 2003-2004. Of the 21 children who had CT scans, 15 (71%) children did not meet American Academy of Neurology guidelines for an emergent CT scan. None of the children had an acute finding on CT, and all were discharged from the emergency department. This finding suggests that the yield of emergent CT scans in children with epilepsy and breakthrough seizure activity is low. This study demonstrates the increasing utilization of CT scans in this population at our institution and that compliance with American Academy of Neurology guidelines is not optimal.
癫痫患儿经常因癫痫发作加剧而在急诊科接受评估。这一群体有接受多次计算机断层扫描（CT）的风险。近年来，多篇文章探讨了与CT扫描相关的长期健康风险。2002年，美国国家癌症研究所发布了一份声明，重点是通过限制儿童接触CT辐射来降低长期健康风险。我们进行了一项回顾性研究，纳入了124名（年龄在2个月至16岁之间）因癫痫和癫痫发作加剧而到我们急诊科就诊的儿童，以确定美国国家癌症研究所的声明是否对头部CT扫描的开具数量产生了影响。我们还评估了医生对美国神经病学学会关于已知癫痫障碍患者紧急头部CT扫描指南的遵守情况以及头部CT扫描的诊断率。从2000 - 2001年到2003 - 2004年，CT扫描的数量有显著增加（P = 0.016）。在进行CT扫描的21名儿童中，15名（71%）儿童不符合美国神经病学学会紧急CT扫描的指南。所有儿童在CT上均未发现急性病变，全部从急诊科出院。这一发现表明，癫痫发作加剧的儿童进行紧急CT扫描的诊断率较低。这项研究表明，在我们机构中，这一群体对CT扫描的使用越来越多，而且对美国神经病学学会指南的遵守情况并不理想。
