TOP 12 - Emergency Department Management of Children with New, Unprovoked Generalized Seizures: Are Providers Complying with Guidelines?

Publication Number: 4714.TOP 12

Selma Cemerlic, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Serena M. Gelfer, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Amy D. Thompson, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States

Background: Unprovoked seizures occur in approximately 0.5–1% of children, many of whom present to the emergency department (ED) for evaluation. National guidelines, including the Choosing Wisely recommendations, advise that children who return to baseline after a first-time, generalized, unprovoked seizure do not require emergent laboratory testing or CT imaging. Despite these guidelines, recent studies report persistently high rates of unnecessary testing but lack detailed clinical context, limiting assessment of the appropriateness of these decisions.

Objective: Our objective was to assess whether diagnostic testing performed in the ED for children with a first-time, generalized, unprovoked seizure aligns with national guidelines and to identify factors influencing testing decisions.

Design/Methods: We conducted a retrospective cohort study of patients aged ≥6 months who were evaluated for a first-time seizure in any emergency department (ED) and subsequently underwent an initial EEG at our tertiary care children’s hospital between January 1, 2023, and December 31, 2024. Patients were identified using EEG procedure codes. Children were excluded if they had fever, known epilepsy, acute head trauma, or a high-risk medical condition at the time of the seizure. Clinical data were abstracted from ED and neurology clinic notes to capture demographics, seizure characteristics, examination findings, and documented indications for testing. Diagnostic testing performed without an abnormal neurological exam, prolonged seizure, or focal seizure was classified as non-adherent to guidelines. We will calculate the prevalence of non-adherent testing and summarize patient characteristics using descriptive statistics (frequencies for categorical variables and medians with interquartile ranges for continuous variables). Bivariate and multivariate logistic regression will be used to examine factors associated with non-adherent management. This study was approved by the Nemours Children’s Hospital Institutional Review Board, and data analysis will be completed by January 2026.