To determine the effect of imaging and electroencephalography on emergency department (ED) length of stay.

Seizures and seizure-like activity comprise 1% of all of pediatric visits to the pediatric ED. There is no clear consensus on the evaluation and management of pediatric patients presenting to the ED with seizures. Guidelines on neuroimaging and encephalography are not based on strong evidence and patients often undergo unnecessary testing that leads to prolonged ED visits. Lower ED length of stay has been linked to improved patient experience and may reduce ED overcrowding.

This is a retrospective cohort study involving patient records over the period of 6 months at an urban tertiary children’s hospital who presented with seizures. Febrile seizures, seizures associated with trauma, and charts of patients who did not present initially through our ED were excluded. 

Univariate analyses between two groups for continuous data were performed by the Mann-Whitney U test with a one-sided p value of <0.05 considered significant.

328 charts were obtained through this search criteria. Head imaging was performed in 52 (16%) patients and consisted of 81% CT (n=42) and 19% (n=10) MRI. Obtaining an MRI was associated with a 3.5 hour longer ED visit (p=0.07); obtaining a CT was associated with a 1.5 hour longer ED visit (p=0.005). EEG was obtained for 67 (20%) visits and was associated with a 3.0 hour longer ED length of stay (p <0.001).

Ten % of the CT scans and 40% of the MRIs done provided useful information for management. Forty-one % of EEGs performed in new onset seizure patients and 5% of EEGs in established seizures provided meaningful findings important to management.

Obtaining neurodiagnostic studies significantly prolongs duration of stay in the ED. Physicians should have a strong logical basis for obtaining studies and must follow national guidelines where applicable.