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.
