Resident physician University Hospitals/Rainbow Babies Children's Hospital Cleveland, Ohio
Rationale: Several studies have been performed to determine the best course of treatment for pediatric patients who present with new onset seizures. Previous studies have focused on provoked seizures, including patients with febrile seizures, known seizure disorders, or those on antiepileptic medications (AEDs). Fewer studies examine patients with unprovoked seizures and their risk of progressing into status epilepticus or developing epilepsy.The purpose of this study is to examine the standard of care for first time unprovoked seizures in pediatric patients. The specific goals of this study are to examine differences in care between patients who are admitted versus patients who are seen in outpatient settings and whether this affected their future clinical outcome. Methods: This was a retrospective chart review of patients seen in a pediatric emergency room or a pediatric neurologist’s office during the time period of 1/1/2005 to 1/10/2020 with a diagnosis of seizure or spell. Patients included in this study were between ages 0 to 21 years. Patients with provoked seizures due to fever, electrolyte abnormalities or trauma were excluded. Other exclusion criteria include having a known underlying seizure disorder or currently taking AEDs. Data was analyzed using Fisher exact test and Chi-Square analysis. A p-value of < 0.05 was considered significant. Results: Of the 96 patient charts reviewed, 62 met the inclusion criteria for the study. Of the 62 patients, 56% were seen in the pediatric ED and admitted inpatient and 44% were seen initially in an outpatient clinic. Factors evaluated include time to CT scan, MRI, routine EEG (rEEG), and initiation of AEDs and development of epilepsy. On average, the time to CT scan was faster in inpatient compared to outpatient (p=0.01). There was no significant difference in obtaining an MRI between the two groups evaluated in this study (p=0.23). The time to rEEG was statistically significant and most often occurred 1-2 days from having a seizure inpatient compared to outpatient (p < 0.01). The time to initiation of AEDs was not significantly different at any time point when comparing inpatient to outpatient. Lastly, of those admitted inpatient, 31% were diagnosed as having epilepsy compared to 44% of those outpatient, which was not statistically significant (p=0.43). Conclusions: These findings suggest that inpatient treatment for first time unprovoked seizures does significantly reduce the time to obtaining at CT scan and rEEG. It does not, however, improve the chances of obtaining an MRI or decrease the time to AED initiation. Determining the best course of evaluation for first time unprovoked seizure is crucial to providing a better standard of care. Further examination is required to determine whether inpatient or outpatient evaluation for a first time unprovoked seizure should be the standard of care as well as decrease health care costs in the long term. Funding: Please list any funding that was received in support of this abstract.: none
