Abstract Details

Title Yield of Etiologic and Actionable Findings in Sedated Brain MRI in Children with New Onset Seizures or Global Developmental Delay: Interim Data Analysis

Topic Child Neurology and Developmental Neurology

Presentation(s) S19 - Child Neurology: Updates in Autism, Migraine, MS, and Stroke (3:30 PM-3:41 PM)

Poster/Presentation
Number 001

Objective To evaluate the yield of brain MRI in terms of etiology and actionable results, in children 1-36 months of age evaluated for new onset seizures (NOS) and/or global developmental delay (GDD)

Background Brain MRI is standard in evaluating children for NOS/GDD, often requiring sedation. Concerns over repeated anesthetic exposure's effect on development, and limited resource availability, prompt an evaluation of rational use of imaging when evaluating these clinical indications.

Design/Methods A retrospective chart review of patients 1-36 months of age who underwent sedated MRI during a 12-month period for NOS/GDD was conducted at Texas Children's Hospital. Patients were excluded if there was suspicion for other pathologies warranting emergent imaging, incorrect indication or history suggesting infantile spasms. MRIs were reviewed by a neuroradiologist. Three neurologists and one neurogeneticist reviewed all MRI data to determine findings 1)providing possible etiology and 2)whether this etiology was actionable. Multivariate regression analysis was performed on the clinical variables.

Results 220 GDD and 334 NOS indications were included. Etiologic yield was 27% for GDD and 13% for NOS; actionable yield was 15% and 5.7%, respectively. Actionability in GDD predominantly included genetic/infectious testing beyond the standard of care (97%). In NOS, neurosurgical (32%), oncology(21%) or child abuse (21%) evaluations were warranted. In GDD, abnormal perinatal history (aOR 2.78, CI 95% 1.46-5.3), and physical exam (aOR 2.21, CI 95% 1.15-4.28) were significant for etiology but only physical exam (aOR 2.26, CI 95% 1.05-486) was associated with actionability. For NOS, only history of abnormal development (aOR 3.81, CI 95% 1.96-7.39) was associated with etiology; no variables were associated with actionability.

Conclusions The yield of MRI for young children with GDD or NOS is low, both in etiology and actionable findings. Additional data may allow for the development of a clinical model to determine which children may benefit from earlier sedated MRI.

Authors/Disclosures
Andres Jimenez Gomez, MD PRESENTER	Dr. Jimenez Gomez has nothing to disclose.
Rachelle Herring, MD (Cook Childrens)	No disclosure on file
	No disclosure on file
	No disclosure on file
Sarah R. Risen, MD	Dr. Risen has nothing to disclose.
	No disclosure on file

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