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.
- emergency department
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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.
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