Early Seizure Recurrence in Children Admitted for Nonfebrile Seizures in the Emergency Department: A Prospective Study.

OBJECTIVE: This study was aimed to determine the rate, timing, and risk factors of acute recurrence of seizures in the children admitted for nonfebrile seizure in the emergency department (ED). METHODS: This multicenter prospective study was conducted in the ED of three hospitals. All consecutive visits of children aged 28 days to 15 years who attended the ED for a nonfebrile seizure for 1 year were included in the study and prospectively followed. The rate of acute seizure recurrence within 24 hours was evaluated and association with potential risk factor was tested. Timing of seizure recurrence was assessed. RESULTS: A total of 181 ED visits were enrolled. Overall, 19.9% (36/181) of children presented acute seizure recurrence, 50% of seizure recurrence occurred during the 2 hours after ED arrival and 70% within 6 hours. Multivariable analysis showed that age of <5 years and seizure recurrence in the emergency department were associated with a significant increase in acute recurrence risk. CONCLUSION: Early seizure recurrence is common in children with nonfebrile seizure, with younger children at higher risk. Based on these findings, acute recurrence risk after a nonfebrile seizure should justify to observe the children admitted for a nonfebrile seizure in the ED, especially young children. A larger study should analyze other risk factors associated with increased risk of acute seizure recurrence and help ED management.

Professional practice assessment: establishment of an institutional procedure to treat blunt abdominal trauma in emergency pediatric department.

OBJECTIVE: The clinical process for the diagnosis of intra-abdominal lesion due to blunt abdominal trauma in children is not consistent. The goal of the present study was to assess the efficiency of our institutional procedure to manage hemodynamically stable pediatric patients with benign abdominal trauma and to select patients who need a radiological examination in an emergency pediatric department. MATERIAL AND METHODS: This was a prospective cohort study from June 2008 to June 2010 in a pediatric emergency department. Pediatric patients with benign abdominal trauma and with stable hemodynamic parameters were included in the study. We conducted first clinical examination and clinical laboratory assessment for blood count, platelet count, hematocrit, serum glutamo-oxalacétique transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), lipase and urine. A second clinical examination was performed 2 h later. Patients with biological abnormalities and/or with persistent pain underwent a computerized tomography (CT) of the abdomen. Our main criterion for judging was the presence of intra-abdominal lesion as revealed by the scan, which was considered as the gold standard. At the second clinical examination, patients without pain and with normal results for clinical laboratory assessment were sent home. A telephone call was made to the children 48 h after the visit to the hospital emergency department. The secondary criterion for judging was the absence of complication in children who did not undergo the scan. RESULTS: A total of 111 children were included. Seventy-five children underwent the complete procedure. Thirty-four scans were performed. The scan revealed that 22 patients had an intra-abdominal lesion. Multivariate analysis indicated that SGOT higher than 34 IU/L and the persistence of pain for more than 2 h from the initial evaluation of trauma favored the development of intra-abdominal lesion. On the basis of these two criteria, we developed a predictive diagnostic score for post-traumatic intra-abdominal injuries with a high negative predictive value. For children who were sent home without a radiological examination, no complications were observed at 48 h after the visit to the emergency department. CONCLUSION: The present protocol is a good approach to identify children at risk for intra-abdominal lesion who need a radiological examination and those who do not require any complementary examinations. The predictive diagnostic score could help young hospital doctors to assess blunt abdominal trauma.

Impact of rotavirus vaccination on hospitalizations for rotavirus diarrhea: the IVANHOE study.

The aim of the IVANHOE study was to determine the real-world impact of the rotavirus vaccine, controlling for epidemic-to-epidemic variation in disease burden. A population-based prospective cohort study was conducted in Brest City and 7 suburban districts (CUB area), North-western Brittany, France (210,000 inhabitants; 5500 births per year). The vaccination program started in May 2007 for a 2-year period for all infants born in the Brest birth zone through pediatricians, public outpatient clinics and general practitioners. To determine vaccine impact we monitored trends in hospitalizations for rotavirus-specific diarrhea using an active hospital-based surveillance system initiated 5 years before vaccine introduction. The number of hospitalizations for rotavirus-specific diarrhea during the 2008/2009 epidemic in infants less than 2 years of age whose parents lived within the CUB area was modelled as a function of (1) the number of hospitalizations in infants 2-5 years of age to control for epidemic-to-epidemic variation and (2) vaccine introduction. A total of 4684 infants received at least one dose. Of these, 2635 lived within the CUB area. Vaccine coverage for a complete schedule in the CUB area was 47.1%. Poisson modelling revealed a reduction by a factor of 2.04 (1.56-2.66) in the number of hospitalizations during the last epidemic season (2008/2009), the number of observed cases being equal to 30, against an expected number of 61. Relative risk reduction for hospitalizations for rotavirus diarrhea was 98% (95% CI: 83-100%). We observed a noticeable impact of vaccination on rotavirus diarrhea hospitalizations within 2 years of vaccine introduction integrating for the first time rotavirus epidemics variation. The trial is registered with ClinicalTrials.gov, number, NCT00740935.