038 - Recognizing ataxia needing intervention: a single-center study of poor prognostic factors in pediatric emergency care

Publication Number: 38.6095

Tsuyoshi Aihara, National Center for Child Health and Development, Tokyo, Tokyo, Japan; Shunsuke Amagasa, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Keiichi Tomita, National Center for Child Health and Development, Setagaya ward, Tokyo, Japan; Itaru Hayakawa, national center for child health and development, Tokyo, Tokyo, Japan; Yuichi Abe, National Center fo Child Health asn Development, Setagaya, Tokyo, Japan; Satoko Uematsu, National Center for Child health and development, Okura, Setagaya-ku, Tokyo, Japan

Background: Acute ataxia in children can range in severity and urgency from benign acute cerebellar ataxia (ACA), which requires no further investigation or treatment, to conditions such as cerebellitis or brain tumors that require early intervention. Although appropriate management during initial assessment is crucial, clear criteria for identifying severe and urgent cases have not been established to date.

Objective: The primary objective of this study was to explore potential prognostic factors associated with poor outcomes in pediatric patients presenting with acute-onset ataxia to guide early intervention.

Design/Methods: This single-center retrospective cohort study was conducted at the National Centre for Child Health and Development between January 2014 and May 2024. Pediatric patients aged 0–18 years who presented with acute-onset ataxia within 7 days of symptom onset were included; those with pre-diagnosed causes of ataxia were excluded. Patients were divided into low- and high-risk groups based on their final diagnosis and prognosis. The benign ACA group included low-risk patients, and the clinically urgent neurological pathology (CUNP) group included high-risk patients. The CUNP group included patients with severe ACA, defined as those requiring treatment or experiencing sequelae, as well as other critically ill patients who required significant interventions, such as immunomodulatory therapy or tumor resection. Statistical analyses, including the chi-square test and multivariate logistic regression, were performed to identify prognostic factors.

Results: Fifty-nine children were included: 34 in the benign ACA group and 25 in the CUNP group. Univariate analysis showed significant differences in headache, vomiting, tremors, age ≥5 years, and symptom persistence beyond 3 days between groups. Multivariate analysis indicated that age ≥5 years (odds ratio (OR) 22.2, 95% confidential interval (CI) 1.8–640.2) and symptom duration over 3 days (OR 8.1, 95% CI 1.5–68.6) were significantly associated with poor outcomes.

Conclusion(s): Pediatric patients aged ≥5 years or with symptoms of acute ataxia lasting beyond 3 days may have a higher risk of requiring treatment or developing sequelae. In such cases, early diagnostic evaluation is essential to avoid delayed intervention. In younger patients whose ataxia symptoms improve rapidly, invasive testing can be avoided. Nonetheless, even if testing is deferred, careful monitoring is necessary.