Do children require hospitalization after immediate posttraumatic seizures?

James F Holmes Jr, Michael J. Palchak, Matthew J. Conklin, Nathan Kuppermann

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Study objective: We determine whether children with immediate posttraurnatic seizures require hospitalization for observation of possible neurologic complications. Methods: This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizures. Patients were examined by faculty emergency physicians and underwent cranial computed tomography (CT) scanning. Children were divided into 2 cohorts according to the presence or absence of traumatic brain injury on cranial CT scan, with the a priori assumption that children with posttraumatic seizures who have abnormal cranial CT scan results require hospitalization. The outcomes of interest were neurologic complications (including further seizure activity or neurologic deficits) or the necessity for neurosurgical intervention. Medical records of hospitalized patients were reviewed, and patients discharged from the emergency department (ED) were contacted by telephone approximately 1 week after hospital discharge to identify those who developed short-term neurologic complications. Results: Sixty-three children with a median age of 7 years (interquartile range 3 to 14 years) had posttraumatic seizures, and all but 1 child underwent cranial CT imaging. Ten (16%; 95% confidence interval [CI] 8% to 27%) patients had traumatic brain injuries on CT scan, and all were hospitalized. Three of these 10 patients underwent craniotomy, and 2 patients had further seizure activity. Fifty-two patients had normal cranial CT scan results, and 20 patients were hospitalized for observation. Telephone follow-up was obtained in 31 of the 32 patients with normal CT scan results who were discharged from the ED. None of the 52 patients (0%; 95% CI 0% to 5.6%) with normal cranial CT scan results had further seizure activity or required neurosurgical interventions. Conclusion: Children with normal neurologic examination results and normal cranial CT scan results after immediate posttraumatic seizures are at low risk for further short-term complications that require immediate hospitalization. These children may be considered for discharge home from the ED.

Original languageEnglish (US)
Pages (from-to)706-710
Number of pages5
JournalAnnals of Emergency Medicine
Volume43
Issue number6
DOIs
StatePublished - Jun 2004

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Seizures
Hospitalization
Tomography
Nervous System
Hospital Emergency Service
Telephone
Observation
Confidence Intervals
Craniotomy
Neurologic Examination
Neurologic Manifestations
Craniocerebral Trauma
Medical Records
Observational Studies
Emergencies
Cohort Studies
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Do children require hospitalization after immediate posttraumatic seizures? / Holmes Jr, James F; Palchak, Michael J.; Conklin, Matthew J.; Kuppermann, Nathan.

In: Annals of Emergency Medicine, Vol. 43, No. 6, 06.2004, p. 706-710.

Research output: Contribution to journalArticle

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abstract = "Study objective: We determine whether children with immediate posttraurnatic seizures require hospitalization for observation of possible neurologic complications. Methods: This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizures. Patients were examined by faculty emergency physicians and underwent cranial computed tomography (CT) scanning. Children were divided into 2 cohorts according to the presence or absence of traumatic brain injury on cranial CT scan, with the a priori assumption that children with posttraumatic seizures who have abnormal cranial CT scan results require hospitalization. The outcomes of interest were neurologic complications (including further seizure activity or neurologic deficits) or the necessity for neurosurgical intervention. Medical records of hospitalized patients were reviewed, and patients discharged from the emergency department (ED) were contacted by telephone approximately 1 week after hospital discharge to identify those who developed short-term neurologic complications. Results: Sixty-three children with a median age of 7 years (interquartile range 3 to 14 years) had posttraumatic seizures, and all but 1 child underwent cranial CT imaging. Ten (16{\%}; 95{\%} confidence interval [CI] 8{\%} to 27{\%}) patients had traumatic brain injuries on CT scan, and all were hospitalized. Three of these 10 patients underwent craniotomy, and 2 patients had further seizure activity. Fifty-two patients had normal cranial CT scan results, and 20 patients were hospitalized for observation. Telephone follow-up was obtained in 31 of the 32 patients with normal CT scan results who were discharged from the ED. None of the 52 patients (0{\%}; 95{\%} CI 0{\%} to 5.6{\%}) with normal cranial CT scan results had further seizure activity or required neurosurgical interventions. Conclusion: Children with normal neurologic examination results and normal cranial CT scan results after immediate posttraumatic seizures are at low risk for further short-term complications that require immediate hospitalization. These children may be considered for discharge home from the ED.",
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