TY - JOUR T1 - Acute ataxia in paediatric emergency departments: a multicentre Italian study JF - Archives of Disease in Childhood JO - Arch Dis Child SP - 768 LP - 774 DO - 10.1136/archdischild-2018-315487 VL - 104 IS - 8 AU - Giacomo Garone AU - Antonino Reale AU - Nicola Vanacore AU - Pasquale Parisi AU - Claudia Bondone AU - Agnese Suppiej AU - Giacomo Brisca AU - Lucia Calistri AU - Duccio Maria Cordelli AU - Salvatore Savasta AU - Salvatore Grosso AU - Fabio Midulla AU - Raffaele Falsaperla AU - Alberto Verrotti AU - Elena Bozzola AU - Cristina Vassia AU - Liviana Da Dalt AU - Rosario Maggiore AU - Stefano Masi AU - Lucia Maltoni AU - Thomas Foiadelli AU - Annalisa Rossetti AU - Carla Greco AU - Silvia Marino AU - Claudia Di Paolantonio AU - Laura Papetti AU - Antonio Francesco Urbino AU - Rossella Rossi AU - Umberto Raucci Y1 - 2019/08/01 UR - http://adc.bmj.com/content/104/8/768.abstract N2 - 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. ER -