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Necessity of lumbar puncture in patients presenting with new onset complex febrile seizures

Erin M Fletcher1, Ghazala Sharieff

  • 1San Diego State University, San Diego, California ; University of California, San Diego, Department of Emergency Medicine, San Diego, California ; Rady Children's Hospital, San Diego, California.

The Western Journal of Emergency Medicine
|May 21, 2013
PubMed

Insights

Acute bacterial meningitis (ABM) is rare in children with a first complex febrile seizure. Patients with two brief febrile seizures in 24 hours may not need lumbar puncture if they lack other neurological symptoms.

Area of Science:

  • Pediatric Emergency Medicine
  • Neurology
  • Infectious Disease

Background:

  • Complex febrile seizures are common in children.
  • Assessing the risk of acute bacterial meningitis (ABM) in this population is crucial.
  • Identifying subgroups at lower risk for serious neurological disease is important.

Purpose of the Study:

  • To characterize patients with a first complex febrile seizure (CFS) in a pediatric ED.
  • To determine the incidence of ABM in this patient group.
  • To identify clinical factors associated with a lower risk of ABM or other serious neurological conditions.

Main Methods:

  • Retrospective cohort study of 193 patients (6 months to 5 years) with a first CFS.
  • Data extracted included demographics, seizure characteristics, and treatments.
  • Analysis of patients with two brief febrile seizures within 24 hours.

Main Results:

  • ABM occurred in 0.5% of patients (1 out of 193).
  • Lumbar puncture was more common in patients with seizure focality, status epilepticus, or intubation.
  • None of the 43 patients with two brief febrile seizures within 24 hours developed ABM or serious neurological disease.

Conclusions:

  • ABM is a rare diagnosis in children presenting with a first complex febrile seizure.
  • Patients with two short febrile seizures within 24 hours may represent a lower-risk group.
  • Lumbar puncture may be unnecessary in this subset without other concerning neurological signs.
Abstract

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