Medical Journal of the Islamic Republic Of Iran
مجله پزشکی جمهوری اسلامی ایران
Med J Islam Repub Iran
Medical Sciences
http://mjiri.iums.ac.ir
2
journal2
1016-1430
2251-6840
8
10.18869/mjiri
14
8888
13
en
jalali
1387
2
1
gregorian
2008
5
1
22
1
online
1
fulltext
en
Excessive testing in emergent evaluation of children with first unprovoked seizure
Pediatric
Pediatric
Original Research
Original Research
<p> <strong> Abstract </strong></p><p> <strong> Backround: </strong>The first episode of an afebrile seizure is a common cause of admission </p><p> of children to emergency departments. Alot of tests are routinely performed for these patients. The cost of such an evaluation is high and benefits are doubtful. We conducted </p><p> this study in order to evaluate the results of the tests and find out what tests are necessary for children with first unprovoked seizure. </p><p> <strong> Methods: </strong>In a 7-year retrospective study files of 150 children aged between 1 month </p><p> and 14 years admitted with first afebrile seizure to the pediatric ward of Rasool Akram </p><p> hospital were reviewed. Reports of the brain neuroimaging studies (Ct-scan & MRI) and </p><p> laboratory tests were extracted. </p><p> <strong> Results: </strong>150 patients with a mean age of 53 ± 48 months qualified for inclusion in the </p><p> study. 143 (95%) of 150 children with first afebrile seizure were imaged. Ninety percent </p><p> (128/143) had normal neuroimaging. Emergent computed tomography as the initial </p><p> study was performed in 90% (128/143) and MRI in 10% (15/143 ). Sixty patients had </p><p> both MRI and CT-scans. Clinically significant neuroimaging abnormalities were reported </p><p> in only 9.7% (14/143). There was a significant relation (P<0.001) between focal </p><p> seizures and abnormal neuroimaging. Children under 24 months of age were also more </p><p> prone to have abnormal imaging (p<0.002). Laboratory tests including complete blood </p><p> count (CBC) and chemistry panel (Na, K, Ca, BUN, Cr) were performed for all. Only </p><p> two patients had low serum calcium level, later diagnosed as vitamin D resistant rickets. </p><p> <strong> Conclusions: </strong>The most important aspect of management of a child after a first </p><p> afebrile seizure is careful history taking and physical examination. Laboratory tests </p><p> should be requested in very limited situations. Emergent brain CT-scans are recommended for children with focal seizures, abnormal findings on physical examination, presence of any predisposing factors and those under 24 months of age. </p><p> </p>
unprovoked seizure, focal seizure, neuroimaging.
17
21
http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-56&slc_lang=en&sid=1
Fariba
Khodapanahandeh
Faribakoda@yahoo.com.
20031947532846001550
20031947532846001550
Yes
Pediatric Department of Rasool-e- Akram Hospital, Sattar Khan AvenueNiyaesh Street, Tehran, Iran,
Mona
Nematian
20031947532846001551
20031947532846001551
No
Rasool-e-Akram Hospital, Iran University of Medical Sciences.
Homayoon
Hadizadeh
20031947532846001552
20031947532846001552
No
Radiology Department of Rasool-e-Akram Hospital, Iran University of Medical Sciences.