Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, 2001 Marcus Avenue Suite W290, Lake Success, NY 11042, USA.
Divison of Epilepsy, Department of Neurology, Northwell Health, 300 Community Dr, 9 Tower, Manhasset, NY 11030, USA.
Epilepsy Behav. 2021 Feb;115:107639. doi: 10.1016/j.yebeh.2020.107639. Epub 2020 Dec 27.
Patients presenting to the pediatric emergency department (ED) often undergo unnecessary testing that leads to prolonged ED visits. Lower ED length of stay has been linked to improved patient experience and may reduce ED overcrowding, a costly burden on a health system.
This is a retrospective cohort study involving patient records over the period of 6 months at an urban tertiary children's hospital who presented with seizures. Febrile seizures, seizures associated with trauma, and charts of patients who did not present initially through our ED were excluded.
328 charts were obtained through this search criteria. Head imaging was performed in 52 (16%) patients and consisted of 81% CT (n = 42) and 19% (n = 10) magnetic resonance imaging (MRI). Obtaining an MRI was associated with a 3.5 h longer ED visit (p = 0.07); obtaining a CT was associated with a 1.5 h longer ED visit (p = 0.005). An Electroencephalogram (EEG) was obtained for 67 (20%) visits and was associated with a 3.0 h longer ED length of stay (p < 0.001). Ten % of the CT scans showed new or progressive findings and 40% of the MRIs done provided useful information for management. Thirty-seven % of EEGs performed in new onset seizure patients revealed epileptiform findings and 5% of EEGs in established seizure patients provided meaningful findings important to management.
Obtaining neurodiagnostic studies significantly prolongs duration of stay in the ED. Electroencephalograms appear to have the greatest yield in new onset seizure patients and can help make a diagnosis of an epilepsy syndrome in children.
儿科急诊就诊的患者常接受不必要的检查，导致就诊时间延长。急诊停留时间缩短与改善患者体验相关，并且可能减少急诊拥堵，这是对医疗系统的一个重大经济负担。
这是一项回顾性队列研究，纳入了一家城市三级儿童医院 6 个月期间因癫痫就诊的患者记录。排除热性惊厥、与创伤相关的癫痫发作以及未通过急诊就诊的患者的病历。
通过该检索标准获得 328 份病历。对 52 名（16%）患者进行了头部影像学检查，包括 81%的 CT（n=42）和 19%的 MRI（n=10）。进行 MRI 检查与 ED 就诊时间延长 3.5 小时相关（p=0.07）；进行 CT 检查与 ED 就诊时间延长 1.5 小时相关（p=0.005）。对 67 次就诊（20%）进行了脑电图（EEG）检查，与 ED 就诊时间延长 3.0 小时相关（p<0.001）。10%的 CT 扫描显示新的或进展性发现，40%的 MRI 检查结果为管理提供了有用的信息。新诊断癫痫发作患者的 EEG 检查中 37%发现癫痫样放电，已确诊癫痫患者的 EEG 检查中 5%发现对管理有重要意义的结果。
神经诊断检查显著延长了 ED 停留时间。脑电图对新诊断的癫痫发作患者似乎有最大的效果，并且有助于对儿童癫痫综合征做出诊断。
