Neurological disorders in pediatric emergency department: From consultation to follow-up of first epileptic seizures.

Abstract

Background: Neurological disorders are a common reason for consultations in pediatric emergency rooms. The aims of this study were 1) to evaluate the role of neurological symptoms in consultations in pediatric emergency departments at a French hospital, and 2) to assess the management of patients presenting with a first seizure in line with the 2020 recommendations of the French National Authority for Health (Haute Autorité de Santé - HAS).

Method: This single-center retrospective observational study was carried out over a period of 16 months, from January 2021 to April 2022. Children referred for neurological symptoms were identified through the ICD10 coding. Demographic data, past medical history for neurological disorder, circumstances of arrival at the emergency room, the occurrence of advice by a child neurologist at the emergency room, and the need for hospitalization were extracted from the files. Statistical analyses were performed in the subgroups of patients consulting for seizures and for headaches. The observance of the HAS guidelines after a first unprovoked seizure was analyzed in looking for EKG and appropriate blood work-up occurrences, and time delays for EEG, MRI, and pediatric neurology consultation.

Results: 734 patients presented for neurological symptoms (2.2 % of emergency consultations). Headaches (n = 282) and seizures (n = 368) represent the most frequent reasons for visits (88.5 %). Of all seizures, a first unprovoked seizure affected 45 patients (12.2 %). Considering HAS recommendations for first seizures, only 3 patients (6.7 %) had a consultation with a pediatric neurologist within 15 days, and 9 patients (20 %) underwent a brain MRI within the first month.

Discussion: Our results confirm the high frequency of consultations for neuropediatric symptoms in French emergency departments, with seizures and headaches being the most common. However, they highlight challenges in obtaining specialist neuropediatric consultations and implementing national recommendations for the management of patients with a first unprovoked seizure.

Conclusion: Based on these results, establishing specialized neurological care networks would enhance patient management and ensure better implementation of HAS recommendations.