Acute ataxia in paediatric emergency departments: a multicentre Italian study

Giacomo Garone, Antonino Reale, Nicola Vanacore, Pasquale Parisi, Claudia Bondone, Agnese Suppiej, Giacomo Brisca, Lucia Calistri, Duccio Maria Cordelli, Salvatore Savasta, Salvatore Grosso, Fabio Midulla, Raffaele Falsaperla, Alberto Verrotti, Elena Bozzola, Cristina Vassia, Liviana Da Dalt, Rosario Maggiore, Stefano Masi, Lucia MaltoniThomas Foiadelli, Annalisa Rossetti, Carla Greco, Silvia Marino, Claudia Di Paolantonio, Laura Papetti, Antonio Francesco Urbino, Rossella Rossi, Umberto Raucci

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalArchives of Disease in Childhood
DOIs
Publication statusE-pub ahead of print - Apr 4 2019

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Ataxia
Multicenter Studies
Hospital Emergency Service
Pediatrics
Pathology
Ophthalmoplegia
Abnormal Reflexes
Logistic Models
Cerebellar Ataxia
Human Herpesvirus 3
Vertigo
Virus Diseases
Consciousness
Migraine Disorders
Brain Neoplasms
Seizures
Emergencies

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Acute ataxia in paediatric emergency departments : a multicentre Italian study. / Garone, Giacomo; Reale, Antonino; Vanacore, Nicola; Parisi, Pasquale; Bondone, Claudia; Suppiej, Agnese; Brisca, Giacomo; Calistri, Lucia; Cordelli, Duccio Maria; Savasta, Salvatore; Grosso, Salvatore; Midulla, Fabio; Falsaperla, Raffaele; Verrotti, Alberto; Bozzola, Elena; Vassia, Cristina; Da Dalt, Liviana; Maggiore, Rosario; Masi, Stefano; Maltoni, Lucia; Foiadelli, Thomas; Rossetti, Annalisa; Greco, Carla; Marino, Silvia; Di Paolantonio, Claudia; Papetti, Laura; Urbino, Antonio Francesco; Rossi, Rossella; Raucci, Umberto.

In: Archives of Disease in Childhood, 04.04.2019.

Research output: Contribution to journalArticle

Garone, G, Reale, A, Vanacore, N, Parisi, P, Bondone, C, Suppiej, A, Brisca, G, Calistri, L, Cordelli, DM, Savasta, S, Grosso, S, Midulla, F, Falsaperla, R, Verrotti, A, Bozzola, E, Vassia, C, Da Dalt, L, Maggiore, R, Masi, S, Maltoni, L, Foiadelli, T, Rossetti, A, Greco, C, Marino, S, Di Paolantonio, C, Papetti, L, Urbino, AF, Rossi, R & Raucci, U 2019, 'Acute ataxia in paediatric emergency departments: a multicentre Italian study', Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2018-315487
Garone, Giacomo ; Reale, Antonino ; Vanacore, Nicola ; Parisi, Pasquale ; Bondone, Claudia ; Suppiej, Agnese ; Brisca, Giacomo ; Calistri, Lucia ; Cordelli, Duccio Maria ; Savasta, Salvatore ; Grosso, Salvatore ; Midulla, Fabio ; Falsaperla, Raffaele ; Verrotti, Alberto ; Bozzola, Elena ; Vassia, Cristina ; Da Dalt, Liviana ; Maggiore, Rosario ; Masi, Stefano ; Maltoni, Lucia ; Foiadelli, Thomas ; Rossetti, Annalisa ; Greco, Carla ; Marino, Silvia ; Di Paolantonio, Claudia ; Papetti, Laura ; Urbino, Antonio Francesco ; Rossi, Rossella ; Raucci, Umberto. / Acute ataxia in paediatric emergency departments : a multicentre Italian study. In: Archives of Disease in Childhood. 2019.
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title = "Acute ataxia in paediatric emergency departments: a multicentre Italian study",
abstract = "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.",
author = "Giacomo Garone and Antonino Reale and Nicola Vanacore and Pasquale Parisi and Claudia Bondone and Agnese Suppiej and Giacomo Brisca and Lucia Calistri and Cordelli, {Duccio Maria} and Salvatore Savasta and Salvatore Grosso and Fabio Midulla and Raffaele Falsaperla and Alberto Verrotti and Elena Bozzola and Cristina Vassia and {Da Dalt}, Liviana and Rosario Maggiore and Stefano Masi and Lucia Maltoni and Thomas Foiadelli and Annalisa Rossetti and Carla Greco and Silvia Marino and {Di Paolantonio}, Claudia and Laura Papetti and Urbino, {Antonio Francesco} and Rossella Rossi and Umberto Raucci",
note = "{\circledC} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",
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language = "English",
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TY - JOUR

T1 - Acute ataxia in paediatric emergency departments

T2 - a multicentre Italian study

AU - Garone, Giacomo

AU - Reale, Antonino

AU - Vanacore, Nicola

AU - Parisi, Pasquale

AU - Bondone, Claudia

AU - Suppiej, Agnese

AU - Brisca, Giacomo

AU - Calistri, Lucia

AU - Cordelli, Duccio Maria

AU - Savasta, Salvatore

AU - Grosso, Salvatore

AU - Midulla, Fabio

AU - Falsaperla, Raffaele

AU - Verrotti, Alberto

AU - Bozzola, Elena

AU - Vassia, Cristina

AU - Da Dalt, Liviana

AU - Maggiore, Rosario

AU - Masi, Stefano

AU - Maltoni, Lucia

AU - Foiadelli, Thomas

AU - Rossetti, Annalisa

AU - Greco, Carla

AU - Marino, Silvia

AU - Di Paolantonio, Claudia

AU - Papetti, Laura

AU - Urbino, Antonio Francesco

AU - Rossi, Rossella

AU - Raucci, Umberto

N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/4/4

Y1 - 2019/4/4

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.

AB - 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.

U2 - 10.1136/archdischild-2018-315487

DO - 10.1136/archdischild-2018-315487

M3 - Article

C2 - 30948362

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

SN - 0003-9888

ER -