Reducing unnecessary investigations in paediatric seizures in the emergency department

Seizures in children are common, representing ~1-2% of all visits to paediatric emergency departments in the US.1 Seizures in children are often categorised as febrile and afebrile. Febrile seizures are the most common neurological disorder in young children, with approximately 3-5% of children having a febrile seizure in the first five years of life.2 These seizures occur between the ages of 6 months and 6 years and are associated with fever, with no evidence of an acute disease of the central nervous system. Simple febrile seizures are generalised in nature, last less than 15 minutes, do not recur in a 24 hour period, and exclude children with known brain abnormalities.2

Afebrile seizures may be provoked (ie, precipitated by an identifiable factor, such as infection of the central nervous system, trauma, or acute neurological insult) or unprovoked. New onset unprovoked afebrile seizures may be the first presentation of an epilepsy syndrome or may represent an isolated event in an otherwise healthy child. Between 0.5% and 1% of children experience a non-recurrent, single unprovoked convulsive episode.3 Retrospective studies from the US, Europe, Asia, and the Middle East suggest that 43-87% of patients who present to the emergency department with unprovoked seizures undergo blood testing,456 while 46-55% undergo urgent neuroimaging.78 Comparatively, …