Prehospital capillary lactate in children differentiates epileptic seizure from febrile seizure, syncope, and psychogenic nonepileptic seizure

Purpose: The aim of the study was to examine prehospital capillary lactate in children as a diagnostic bio-marker to differentiate epileptic seizures from febrile seizures, syncope, and psychogenic nonepileptic seizures (PNES). Methods: Capillary lactate concentrations taken in a pediatric prehospital setting within 2 h of the parox-ysmal event were compared retrospectively between patients with epileptic seizure, febrile seizure, syn-cope, and PNES, based on the final diagnosis from the hospitalization report. Results: One hundred and two patients were included, 53 (52%) with epileptic seizures, 41 (40%) with febrile seizures, and 8 (8%) with syncope or PNES. Capillary lactate in patients with a final diagnosis of epileptic seizure was significantly increased in comparison to the concentrations in patients with febrile seizure (p < 0.0007) and in comparison to the concentrations in patients with syncope or PNES (p < 0.0204). The area under the ROC-curve was 0.71 (95% CI 0.61-0.80). For a cutoff concentration of pre -hospital capillary lactate >3.9 mmol/l (Youden index), the sensitivity was 49% and the specificity 92%. Conclusion: Prehospital capillary lactate concentrations are a useful tool for differentiating the nature of a paroxysmal event in children. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

The purpose of this study was to examine prehospital capillary lactate as a diagnostic biomarker in children to differentiate epileptic seizures from other conditions. The results showed that capillary lactate concentrations were significantly increased in patients with epileptic seizures compared to those with febrile seizures or syncope/PNES. Prehospital capillary lactate concentrations are a useful tool for differentiating the nature of a paroxysmal event in children.