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Seizures and fever: can we rule out meningitis on clinical grounds alone?

M Offringa1, A Beishuizen, G Derksen-Lubsen

  • 1Department of Pediatrics, University Hospital Rotterdam, The Netherlands.

Clinical Pediatrics
|September 1, 1992
PubMed

Insights

Meningitis in children with fever and seizures can often be ruled out using clinical signs in the emergency room. This study suggests cerebrospinal fluid tests may not be routinely needed for febrile seizures.

Area of Science:

  • Pediatrics
  • Neurology
  • Infectious Diseases

Background:

  • Febrile seizures are common in children.
  • Meningitis is a serious infection that can cause seizures.
  • Accurate diagnosis in the emergency room (ER) is crucial.

Purpose of the Study:

  • To determine if clinical information from ER examinations can reliably identify or exclude meningitis in children with a first seizure and fever.
  • To assess the necessity of routine cerebrospinal fluid (CSF) investigation.

Main Methods:

  • A study of 309 children presenting to two ERs with a first seizure and fever.
  • Comparison of children diagnosed with meningitis (23 cases) versus a control group (69 children) without meningitis.
  • Identification of clinical signs differentiating the two groups.

Main Results:

  • Key ER signs for meningitis included petechiae, nuchal rigidity, coma, persistent drowsiness, ongoing convulsions, and paresis/paralysis.
  • These signs identified 21 of the 23 meningitis cases.
  • Children without these signs or complex seizure features were unlikely to have meningitis.

Conclusions:

  • Clinical assessment in the ER can effectively rule out meningitis in children with seizures and fever.
  • Routine CSF investigation may not be necessary, potentially reducing invasive procedures and healthcare costs.

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