The Role of Routine Serum Laboratory Tests in Children Presenting to the Emergency Department with Unprovoked Seizures

Abstract

The role of laboratory tests in the treatment of patients with unprovoked seizures in the emergency department (ED) is unclear. To better determine the diagnostic value of routine serum chemistries (glucose, electrolytes) in these patients, and to identify risk factors predicting abnormality, 107 children who presented to the ED with unprovoked seizures were evaluated prospectively. Serum electrolytes and glucose were determined in 54 patients. The incidence of abnormal serum biochemical values was 14.8%; it was higher in patients with a first seizure, younger age, gastrointestinal symptoms, or change in mental status. These data indicate that serum glucose and/or electrolyte abnormalities are rare in patients evaluated in the ED for unprovoked seizures. Based on these findings and those reported in previous studies, performance of these tests is recommended in children younger than 2 years old, presenting with a first seizure, or when accompanied by gastrointestinal or diffuse neuralgic symptoms.

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References

1. Wolf SM . Laboratory evaluation of the child with a febrile convulsion. Pediatrics. 1978;62:1074-1076.

2. Wears RL , Luten RC , Lyons RG . Which laboratory tests should be performed on children with apparent febrile convulsions? An analysis and review of the literature. Pediatr Emerg Care. 1986;2:191-196.

3. Krumholz A , Grufferman S , Orr ST , Stern BJ . Seizures and seizure care in an emergency department. Epilepsia. 1989;30:175-181.

4. Pellegrino TR . An emergency department approach to first-time seizures. Emerg Med Clin North Am. 1994;12:925-939.

5. Behrman RE , Kliegman RM , Arvin AM , et al. Nelson Textbook of Pediatrics. Philadelphia: WB Saunders, 1996:2035-2056.

6. Powers RD . Serum chemistry abnormalities in adult patients with seizures. Ann Emerg Med. 1985;14:416-420.

7. Eisner RF , Turnbull TL , Howes DS , Gold IW . Efficacy of a "standard" seizure workup in the emergency department. Ann Emerg Med. 1986;15:33-39.

8. Mc Kee PJ , Wilson EA , Dawson JA , Larkin JG , Brodie MJ . Managing seizures in the casualty department. BMJ. 1990;300:978-979.

9. Turnbull TL , Vanden Hoek TL , Howes DS , Eisner RF . Utility of laboratory studies in the emergency department patient with a new-onset seizure. Ann Emerg Med. 1990;19:373-377.

10.

10. Sempere AP , Villaverde FJ , Martinez-Menendez B , Cabeza C , Pena P , Tejerina JA . First seizure in adults: a prospective study from the emergency department. Acta Neurol Scand. 1992;86:134-138.

11.

11. Henneman PL , De Roos F , Lewis RJ . Determining the need for admission in patients with new-onset seizures. Ann Emerg Med. 1994;24:1108-1114.

12.

12. Tardy B , Lafond P , Convers P , et al. Adult first generalized seizure: etiology, biological tests, EEG, CT scan, in an ED. Am J Emerg Med. 1995;13:1-5.

13.

13. Landfish N , Gieron-Korthals M , Weibley RE , Panzarino V. New onset childhood seizures. Emergency department experience. J Fla Med Assoc. 1992;79:697-700.

14.

14. Nypaver MM , Reynolds SL , Tanz RR , Davis AT . Emergency department laboratory evaluation of children with seizures: dogma or dilemma? Pediatr Emerg Care. 1992;8:13-16.

15.

15. Rutter N , Smales OR . Role of routine investigations in children presenting with their first febrile convulsion. Arch Dis Child. 1977;52:188-191.

16.

16. Jaffe M , Bar-Joseph G , Tirosh E. Fever and convulsions-indications for laboratory investigations. Pediatrics. 1981;67:729-731.

17.

17. Gerber MA , Berliner BC . The child with a 'simple' febrile seizure. Appropriate diagnostic evaluation. Am J Dis Child. 1981;135:431-433.

18.

18. Kenney RD , Taylor JA . Absence of serum chemistry abnormalities in pediatric patients presenting with seizures. Pediatr Emerg Care. 1992;8:65-66.

19.

19. Scarfone RJ , Pond K , Thompson K , Fall I. Utility of laboratory testing for infants with seizures. Pediatr Emerg Care. 2000;16:309-312.

20.

20. Clinical policy for the initial approach to patients presenting with a chief complaint of seizure who are not in status epilepticus. American College of Emergency Physicians. Ann Emerg Med. 1997;29:706-724.

21.

21. Rivers PA , Tsai KL . Managing costs and managing care. Int J Health Care Assur Inc Leadership Health Serv. 2001;14:302-307.

22.

22. Portugal B. Benchmarking hospital laboratory financial and operational performance. Hosp Technol Ser 1993;12:1-21.

23.

23. James BC . Implementing practice guidelines through clinic quality improvement. Front Health Serv Manage. 1993;10:3-37.