Recognizing ataxia requiring intervention: a retrospective cohort study of poor prognostic factors in pediatric emergency department patients

Purpose

We aimed to explore the potential prognostic factors associated with poorer outcomes in pediatric patients presenting with acute-onset ataxia to guide early intervention.

Methods

This single-center retrospective cohort study was conducted at the National Center for Child Health and Development between January 2014 and May 2024. Pediatric patients aged 0–18 years who presented with acute-onset ataxia within 7 days of symptom onset were included, excluding those with pre-diagnosed causes of ataxia. Patients were divided into two groups based on their final diagnosis and prognosis: the benign acute cerebellar ataxia (ACA) group for low-risk patients and the clinically urgent neurological pathology (CUNP) group for high-risk patients. Statistical analyses, including chi-square tests and multivariate logistic regression, were performed to identify prognostic factors.

Results

In total, 59 children were included: 34 in the benign ACA group and 25 in the CUNP group. Univariate analysis showed significant differences in headache, vomiting, tremors or dysmetria, age ≥ 5 years, and symptom persistence beyond 3 days between the two groups. Multivariate analysis indicated that age ≥ 5 years (odds ratio [OR] 22.2, 95 % confidence interval [CI] 1.8–640.2) and symptom persistence over 3 days (OR 8.1, 95 % CI 1.5–68.6) were significantly associated with poorer outcomes.

Conclusion

Pediatric patients aged ≥5 years with symptoms persisting for more than 3 days are more likely to require treatment or develop sequelae. Early diagnostic evaluation is important in such cases to avoid delayed intervention.