Veerapandiyan Aravindhan, Aravindhan Akilandeswari, Takahashi James Huynh, Segal Devorah, Pecor Keith, Ming Xue
1 Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
2 Woodland Park Pediatrics, Woodland Park, NJ, USA.
J Child Neurol. 2018 Oct;33(11):708-712. doi: 10.1177/0883073818786086. Epub 2018 Jul 10.
Cranial computed tomography (CT) is not recommended in the routine evaluation of children with first afebrile seizure due to its low yield. The objective was to assess the current practice in our pediatric emergency department regarding the use of head CT in children with first afebrile seizure and to identify the factors that lead to ordering a head CT.
Medical records of patients between 1 month and 18 years old evaluated at our emergency department for presentation of first afebrile seizure between 2010 and 2014 were retrospectively reviewed. Data extracted include age, gender, seizure type, single or multiple seizures at presentation, seizure duration, predisposing conditions to seizures (ie, history of developmental delay), and whether a head CT was performed. Contingency tables with chi-square analyses were used to determine which variables were associated with increased use of head CT.
Of 155 patients (88M/67F) included in the study, 72 (46.5%) underwent head CT and only 3 had clinically significant findings that did not require acute management. There were no differences in CT use by age, sex, seizure type, seizure number, seizure risk factors, or findings on physical examination. Head CT was performed more frequently in cases with seizures ≥5 minutes and unknown seizure duration ( P = .04).
Despite existing evidence, the emergent head CT rate was high in our cohort. Children with seizure duration of ≥5 minutes or of unknown duration were more likely to undergo head CT in our emergency department.
由于头颅计算机断层扫描（CT）的阳性率较低，不建议将其用于首次无热惊厥儿童的常规评估。本研究的目的是评估我们儿科急诊科对首次无热惊厥儿童使用头颅CT的当前做法，并确定导致开具头颅CT检查的因素。
回顾性分析2010年至2014年期间在我们急诊科就诊的1个月至18岁首次无热惊厥患者的病历。提取的数据包括年龄、性别、癫痫发作类型、就诊时的单次或多次发作、发作持续时间、癫痫发作的诱发因素（即发育迟缓病史）以及是否进行了头颅CT检查。使用列联表和卡方分析来确定哪些变量与头颅CT使用增加相关。
本研究纳入的155例患者（88例男性/67例女性）中，72例（46.5%）接受了头颅CT检查，只有3例有临床显著发现但不需要紧急处理。在CT使用方面，年龄、性别、癫痫发作类型、发作次数、癫痫发作危险因素或体格检查结果之间没有差异。癫痫发作≥5分钟且发作持续时间不明的病例中，头颅CT检查的频率更高（P = 0.04）。
尽管有现有证据，但我们队列中的急诊头颅CT使用率很高。在我们的急诊科，癫痫发作持续时间≥5分钟或持续时间不明的儿童更有可能接受头颅CT检查。
