The burden of neurological disorders in the pediatric emergency setting: Insight for planning the neurological care

Editorial Neurological disorders are frequent conditions in the pediatric emergency setting. Moreover, it is a general experience that acute neurological emergencies are associated with greater frequency of pediatric intensive care unit admissions, high mortality rate and permanent neurological sequelae in the survivors. Research in this field mainly dealt with single types of neurological disorders giving important information on diagnostic pathways and clues for identifying patients with the greatest probability of threatening conditions [1,2]. A broader view of the topic is still scarcely documented in the literature, but, it is needed to improve the organization of neurological care in the pediatric emergency departments (PEDs). In this issue of the European Journal of Pediatric Neurology, Personnic et al. [3] performed a retrospective analysis of a large cohort of children presenting with neurological complaints on arrival to the PED of an academic tertiary care hospital. They found a 3,4% prevalence of neurological complaints over 80,320 yearly visits, confirming the high burden of neurological problems attending PEDs. They also showed that of 806 patients with a final neurological diagnosis 30% were admitted and 2% required intensive care, confirming the severity of the neurological burden in PEDs. The main issue in the emergency setting is to recognize patients with potentially severe underlying disorders. Clinical conditions such as stroke, status epilepticus, intracranial hypertension and central nervous system malignancies, require special training for timely diagnosis and management, in order to minimize the neurological sequelae. Personnic et al. [3] found that seizures were the most frequent neurological diagnosis accounting for 55.9% of the final diagnoses and the second most frequent neurological complaint with 93.8% consistency between complaint on arrival and final neurologic diagnosis. Thus, as the authors suggested, it will be desirable that healthcare professional working in PEDs would receive appropriate training in epileptology and in the acute management of seizures and status epilepticus. The first most common complaint was headache but about half of the cases were non neurological and only few of those being neurological were secondary to potentially severe identified causes. Thus one other important focus of the neurological training for pediatricians working in PEDs should be on red flags for secondary neurological headache and its acute management [4]. Overall, Personnic et al.’s study gives interesting insight into the scenario of child neurology in the emergency setting. It would be desirable that the neurohospitalist model adopted in adults be generalized to pediatrics, but the optimal model is still unclear [5]. In the absence of a child neurologist dedicated to PEDs, special training should be provided to the pediatricians working in PEDs, as suggested by Personnic et al. Considering that the far most frequent neurological diagnoses are seizures and headache, training should focus on the recognition and acute management of these disorders, while for rarer neurological diagnoses it will be important to guarantee the availability of prompt consultation with the child neurologist.