Clinical assessment of children with first-attack seizures admitted to the ED

Purpose: This study aims to evaluate clinical values and determine the function of a pediatric observation unit (POU) as an alternative to inpatient unit admission for children with newly onset seizures. Basic Procedures: Pediatric patients who were sent to the emergency department (ED) with new-onset seizure were retrospectively analyzed in a 6-year study period. All patients were divided into 3 groups: POU-discharged, unplanned inpatient admission, and required admission. Basic demographics, clinical course, biologic data, and radiologic findings were analyzed among the 3 groups. Main Findings: From the 910 children admitted to the ED with first attack of seizure, 405 (44.5%; mean age, 2.86 ± 2.64 years) were admitted to the POU. Of them, 184 (45.4%) were later discharged. Using multivariate logistic regression analysis, patients with febrile seizure, those without elevated serum C-reactive protein level, and those who did not require first-line anticonvulsants in the ED were associated with an increased trend of POU discharge. Principal Conclusions: The POU may be an alternative to immediate admission in selected cases of first seizures. Related information such as age, use of anticonvulsants in the ED, serum C-reactive protein value, and clinical diagnosis of febrile seizure are important factors for determining whether pediatric patients with first seizure attack should be admitted or discharged.