The Importance of Post-Seizure Observations in Children

Introduction

This article discusses the risk of not thoroughly observing children post-seizure.

A Case Example

A 10-year-old patient was admitted with a 3-week headache, sudden vomiting and dizziness. After admission, the patient suffered multiple convulsions. Post-seizure observations were not completed in accordance with the Paediatric Early Warning System Policy and a CT Scan was not performed. The patient was transferred to another hospital and died 3 days later of acute intracranial haemorrhage and ruptured congenital arteriovenous malformation.

Independent Recommendations to Improve Healthcare Standards and Patient Safety

Children presenting with vomiting and dizziness is always a cause for concern, especially when they have recurring headaches for a prolonged length of time. In instances where the child has been having unexplained headaches and they suddenly take a turn for the worse, proactive action needs to be undertaken to get to the root of the issue. These symptoms should always be assumed to have a neurological basis, until proven otherwise and thorough observations should ensue, especially when seizures occur.

In cases suggestive of intracranial pathology, CT imaging can help diagnose the neurological issue in a timely manner and can prevent the situation from deteriorating.

A study by TMLEP shows that in these instances, when a child is presenting with prolonged headaches, vomiting and dizziness, a CT Scan should be considered, especially if one or more of the following symptoms are also present:

  • Night-time headache (This in itself is a red flag for a brain tumour or intracranial pressure)
  • Diplopia
  • Lethargy or the want to sleep in the middle of the day where it is abnormal for the child to do so
  • Weakness and sudden inability to stand or walk
  • Abrupt change in condition
  • Seizures
  • Reduced conscious level, hypertension and bradycardia (presenting together)

A CT scan of the head takes a few minutes, and the patient can be monitored throughout. Even when presenting with a depressed level of consciousness, the anaesthetic team can assist with taking the patient to the scan and so there is rarely a reason to forgo a CT scan in light of these above symptoms.

Following a seizure, clinicians should bear in mind the urgency of referring the patient for a CT scan, to attempt to quickly diagnose the issue before another seizure occurs or before the patient further deteriorates.

Conclusions

It is crucial to undertake thorough investigations when a child presents with prolonged headaches, vomiting and dizziness. If a CT scan has not been performed, one should always be arranged following a seizure to get to the root cause of the problem, so that the correct pathway can ensue.

It is important to consider that a CT scan can not only diagnose, but also rule out differential diagnoses such as tumours or other neurological symptoms which can further reduce the scope when diagnosing a child in these emergency situations.

By raising awareness of the above issues, THEMIS aims to assist in developing awareness of post-seizure observations and the importance of undertaking a CT scan, therefore improving clinical care and reducing litigation risk.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable.