RT Journal Article
SR Electronic
T1 Acute ataxia in paediatric emergency departments: a multicentre Italian study
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP archdischild-2018-315487
DO 10.1136/archdischild-2018-315487
A1 Giacomo Garone
A1 Antonino Reale
A1 Nicola Vanacore
A1 Pasquale Parisi
A1 Claudia Bondone
A1 Agnese Suppiej
A1 Giacomo Brisca
A1 Lucia Calistri
A1 Duccio Maria Cordelli
A1 Salvatore Savasta
A1 Salvatore Grosso
A1 Fabio Midulla
A1 Raffaele Falsaperla
A1 Alberto Verrotti
A1 Elena Bozzola
A1 Cristina Vassia
A1 Liviana Da Dalt
A1 Rosario Maggiore
A1 Stefano Masi
A1 Lucia Maltoni
A1 Thomas Foiadelli
A1 Annalisa Rossetti
A1 Carla Greco
A1 Silvia Marino
A1 Claudia Di Paolantonio
A1 Laura Papetti
A1 Antonio Francesco Urbino
A1 Rossella Rossi
A1 Umberto Raucci
YR 2019
UL http://adc.bmj.com/content/early/2019/04/03/archdischild-2018-315487.abstract
AB 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.