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Original article
Acute ataxia in paediatric emergency departments: a multicentre Italian study
  1. Giacomo Garone1,
  2. Antonino Reale2,
  3. Nicola Vanacore3,
  4. Pasquale Parisi4,
  5. Claudia Bondone5,
  6. Agnese Suppiej6,7,
  7. Giacomo Brisca8,
  8. Lucia Calistri9,
  9. Duccio Maria Cordelli10,
  10. Salvatore Savasta11,
  11. Salvatore Grosso12,
  12. Fabio Midulla13,
  13. Raffaele Falsaperla14,
  14. Alberto Verrotti15,
  15. Elena Bozzola16,
  16. Cristina Vassia5,
  17. Liviana Da Dalt17,
  18. Rosario Maggiore8,
  19. Stefano Masi9,
  20. Lucia Maltoni10,
  21. Thomas Foiadelli11,
  22. Annalisa Rossetti12,
  23. Carla Greco13,
  24. Silvia Marino14,
  25. Claudia Di Paolantonio15,
  26. Laura Papetti18,
  27. Antonio Francesco Urbino5,
  28. Rossella Rossi2,
  29. Umberto Raucci2
  1. 1 University Hospital Pediatric Department, Bambino Gesù Children’s Hospital IRCCS, University of Rome Tor Vergata, Rome, Italy
  2. 2 Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  3. 3 National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
  4. 4 Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
  5. 5 Department of Pediatric Emergency, Regina Margherita Pediatric Hospital, Turin, Italy
  6. 6 Child Neurology and Clinical Neurophysiology, Department of Woman and Child Health, University of Padua, Padova, Italy
  7. 7 Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
  8. 8 Pediatric Emergency Department, Giannina Gaslini Children’s Hospital, Genoa, Italy
  9. 9 Pediatric Emergency Unit, Anna Meyer Children’s Hospital, Florence, Italy
  10. 10 Child Neurology Unit, University of Bologna, Bologna, Italy
  11. 11 Department of Pediatrics, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy
  12. 12 Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
  13. 13 Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
  14. 14 Unit of Pediatrics and Emergency Pediatrics, AOU Policlinico Vittorio Emanuele, Catania, Italy
  15. 15 Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
  16. 16 Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  17. 17 Pediatric Emergency Department, Department of Woman’s and Child Health, University of Padova, Padova, Italy
  18. 18 Division of Neurology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  1. Correspondence to Dr Umberto Raucci, Emergency Department, Bambino Gesù Children Hospital, Rome 00165, Italy; umberto.raucci{at}opbg.net

Abstract

Objectives To evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP).

Study design This is a retrospective medical chart analysis of children (1–18 years) attending to 11 paediatric emergency departments (EDs) for AA in an 8-year period. A logistic regression model was applied to identify clinical risk factors for CUNP.

Results 509 patients (mean age 5.8 years) were included (0.021% of all ED attendances). The most common cause of AA was acute postinfectious cerebellar ataxia (APCA, 33.6%). Brain tumours were the second most common cause (11.2%), followed by migraine-related disorders (9%). Nine out of the 14 variables tested showed an OR >1. Among them, meningeal and focal neurological signs, hyporeflexia and ophthalmoplegia were significantly associated with a higher risk of CUNP (OR=3–7.7, p<0.05). Similarly, the odds of an underlying CUNP were increased by 51% by each day from onset of ataxia (OR=1.5, CI 1.1 to 1.2). Conversely, a history of varicella-zoster virus infection and vertigo resulted in a significantly lower risk of CUNP (OR=0.1 and OR=0.5, respectively; p<0.05).

Conclusions The most frequent cause of AA is APCA, but CUNPs account for over a third of cases. Focal and meningeal signs, hyporeflexia and ophthalmoplegia, as well as longer duration of symptoms, are the most consistent ‘red flags’ of a severe underlying pathology. Other features with less robust association with CUNP, such as seizures or consciousness impairment, should be seriously taken into account during AA evaluation.

  • cerebellitis
  • emergency department
  • child
  • neurology
  • ataxia

https://doi.org/10.1136/archdischild-2018-315487

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    Footnotes

    • GG and UR contributed equally.

    • Contributors UR and GG conceptualised and designed the study, coordinated and supervised the data collection, interpreted the data, drafted the initial manuscript, provided critical review and revision of the manuscript, and wrote the final manuscript. NV performed the statistical analysis, interpreted the data, contributed to conceptualising the study and participated in the design of the study, and reviewed and revised the initial manuscript. ARe and PP contributed to conceptualising the study and participated in the design of the study, interpreted the data, and reviewed and revised the initial manuscript. CB, AS, GB, LC, DMC, SS, SG, FM, RF, AV, EB, CV, LDD, RM, SMas, LM, TF, AR, CG, SMar, CDP, LP, AFU and RR contributed to conceptualising the study, collected the data, and reviewed and revised the initial manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The institutional ethics committee of each participating hospital approved the study protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.