Complex Febrile Seizures, Lumbar Puncture, and Central Nervous System Infections: A National Perspective

Area of Science:

• Pediatric Emergency Medicine
• Neurology
• Infectious Diseases

Background:

• Complex febrile seizures (CFS) are common in pediatric emergency departments.
• Lumbar puncture (LP) is often performed to rule out central nervous system (CNS) infections.
• Practice patterns for LP in CFS may vary nationally.

Purpose of the Study:

• To determine national practice patterns for lumbar puncture (LP) in children with complex febrile seizures (CFS).
• To compare LP rates with the incidence of central nervous system (CNS) infections in this population.
• To analyze trends in LP utilization and patient disposition.

Main Methods:

• Retrospective study of emergency department (ED) visits for CFS in patients aged 0-5 years (2007-2014).
• Analysis of national sample data to determine LP frequency, CNS infection incidence, and ED disposition.
• Statistical analysis to identify trends and significant differences.

Main Results:

• Of 28,810 ED visits for CFS, LP was performed in 25.8%.
• The rate of LP decreased from 31.4% to 17.8% over the study period.
• CNS infections were diagnosed in only 0.3% of encounters; common diagnoses included otitis media and upper respiratory infections.
• Hospital admission occurred in 51.0% of encounters.

Conclusions:

• Lumbar puncture is performed in approximately one-fourth of pediatric ED encounters for CFS.
• The very low incidence of CNS infections suggests that LP could be avoided in many cases.
• Declining LP rates indicate a potential shift towards more selective use of this invasive procedure.