APHP. Service de Neurologie Pédiatrique, Hôpital Robert-Debré, Paris, France; APHP, Service de Pédiatrique, Hôpital Ambroise-Paré, France; APHP. Service des urgences pédiatriques, Hôpital Robert-Debré, Paris, France.
APHP. Service de Neurologie Pédiatrique, Hôpital Robert-Debré, Paris, France; Université de Paris, INSERM NeuroDiderot, Paris, France; Institut Universitaire de France (IUF), Paris, France.
Eur J Paediatr Neurol. 2022 Sep;40:44-50. doi: 10.1016/j.ejpn.2022.06.010. Epub 2022 Jun 20.
Neurological disorders, in particular seizure, are one of the reasons for admission in pediatric emergency departments (PED). We aimed to evaluate the frequency and the relevance of each investigation for seizure management in the PED.
We conducted a one-year retrospective study. Based on predefined criteria, we evaluate the appropriateness of the investigations. Logical regression was used to study the risk factors for acute symptomatic seizure (ASS).
We identified 691 visits to the PED for an epileptic event over an annual volume of 80,320 visits. Seizures occurring in Children with epilepsy were the most frequent epileptic events seen in the PED (42%). Looking at the investigation performed in the PED, a blood electrolytes analysis was performed in 26%, neuroimaging in 9%, electroencephalography recording in 9% and LP in 5% of patients. ASSs represented 2.1% of the seizures and 0.6% of PED neurological visits. In the multivariate analysis, an initial abnormal neurological examination (OR, 20.92 [4.87; 89.81, p<0.0001) was the only risk factor that remained significantly associated with ASS. A seizure occurring in an epilepsy patient was significantly associated with an unprovoked seizure (OR, 0.12 [0.02; 0.57], p<0.008).
All ASSs were associated with a positive or abnormal examination. Moreover, there is a significant proportion of investigations requested in cases of an epileptic event that did not lead to a diagnosis or modification of the management. Based on our methods, there seems to be an overuse of investigations for seizure in children with epilepsy.
神经系统疾病，尤其是癫痫发作，是小儿急诊科（PED）收治的原因之一。我们旨在评估 PED 中每种检查对癫痫管理的频率和相关性。
我们进行了一项为期一年的回顾性研究。根据预先确定的标准，我们评估了检查的适宜性。逻辑回归用于研究急性症状性癫痫发作（ASS）的危险因素。
我们在每年 80320 次就诊中，发现 691 次因癫痫发作而到 PED 就诊。在 PED 中，癫痫儿童的癫痫发作是最常见的癫痫发作（42%）。在 PED 中进行的检查中，进行了血液电解质分析的占 26%，神经影像学检查占 9%，脑电图记录占 9%，腰椎穿刺占 5%。ASS 占癫痫发作的 2.1%，占 PED 神经就诊的 0.6%。在多变量分析中，初始异常神经检查（OR，20.92 [4.87; 89.81，p<0.0001）是与 ASS 显著相关的唯一危险因素。癫痫患者的癫痫发作与无诱因的癫痫发作显著相关（OR，0.12 [0.02; 0.57]，p<0.008）。
所有 ASS 均与阳性或异常检查相关。此外，在癫痫发作的情况下，有相当比例的检查没有导致诊断或管理的改变。根据我们的方法，似乎对癫痫儿童的癫痫发作检查存在过度使用。
