Predictors of recurrent seizure before admission in children presented with seizure to emergency department

Objective: To identify predictors for short term recurrence in young children presented with seizure to the accident & emergency department (A&E) in Hong Kong. Methods: It was a retrospective cohort analysis based on A&E data from one district hospital. The study period was from 1st January 2008 to 31st December 2012. All children aged below 6 years presented with seizure attended A&E who required admissions to paediatric ward were included. Baseline characteristic factors were recorded. Primary outcome was presence of recurrent seizure before admission to paediatric ward. Binominal logistic regression was applied to identify the predictive factors. Results: Total 650 cases were included for analysis. Recurrent seizure before admission occurred in 101 cases (15.5%). Final diagnoses consisted of febrile seizure (77.8%), afebrile seizure (6.6%), epilepsy (13.8%), status epilepticus (1.2%) and others (0.5%). Statistically significant predictive factors include pre-hospital seizure duration 5-15 minutes (odds ratio [OR]=2.960; p<0.001), pre-hospital seizure duration more than 15 minutes (OR=16.164; p<0.001), history of prematurity (OR=3.941; p=0.006), history of epilepsy (OR=2.531; p=0.010) and fever in A&E (>= 38 degrees C) (OR=2.072; p=0.030). Conclusions: In children aged below 6 years presented with seizure to A&E, prior seizure duration of 5-15 minutes, prior seizure duration of more than 15 minutes, history of prematurity, history of epilepsy and fever in A&E are independent predictors for recurrent seizure before admission.