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Trends in the Management of Complex Febrile Seizures Across Children's Hospitals
James F Buscher1,2, Chelsey R McConnell1,2, Laura A Ortmann1,2
1Department of Pediatrics, University of Nebraska Medical Center, College of Medicine.
Insights
Resource use for complex febrile seizures (CFS) management decreased significantly from 2009 to 2021. This trend occurred without an increase in serious medical diagnoses, suggesting opportunities for standardized care.
Area of Science:
- Pediatric Neurology
- Clinical Resource Utilization
- Evidence-Based Medicine
Background:
- Guidelines for simple febrile seizures have impacted resource use, but management trends for complex febrile seizures (CFS) remain less understood.
- No specific clinical guidelines currently exist for the management of CFS.
Purpose of the Study:
- To evaluate trends in the management and resource utilization for complex febrile seizures (CFS) in children.
- To identify changes in diagnostic testing, medication use, and hospital admission patterns over time.
Main Methods:
- Retrospective review of 17,865 pediatric emergency department encounters for CFS from 36 children's hospitals (2009-2021).
- Data analyzed across three distinct time periods: pre-guideline release (2009-2011) and two post-guideline periods (2011-2016, 2016-2021).
- Primary outcome measured was medical resource use, including neuroimaging, laboratory tests, lumbar puncture, EEG, and medication administration.
Main Results:
- Overall resource use, including neuroimaging, labs, and lumbar puncture, decreased over the study period.
- Use of antiseizure medications, antibiotics, and acyclovir also declined.
- Median length of stay decreased, and the incidence of new serious diagnoses remained low (0.2%).
Conclusions:
- Medical resource utilization for complex febrile seizures has decreased since 2009.
- This reduction in resource use has not been associated with an increase in serious medical diagnoses.
- Findings suggest potential for standardizing the management of CFS to optimize resource allocation.
Background And Objectives:
Resource use for managing simple febrile seizures decreased after the publication of guidelines. Less is known about resource use for complex febrile seizures (CFS), for which no guidelines exist. The objective of this study was to evaluate trends in management of CFS.
Methods:
Using the Pediatric Health Information System (PHIS) Database, we retrospectively reviewed encounters of children 6 months to 6 years old presenting to the emergency department for a first encounter for CFS between January 1, 2009 and December 31, 2021. Data were compared between 3 distinct periods as follows: (1) before release of the simple febrile seizures guidelines-January 1, 2009 to January 31, 2011, and 2 subsequent 5-year time periods postguideline release; (2) February 1, 2011 to January 31, 2016; and (3) February 1, 2016 to December 31, 2021. The primary outcome was use of medical resources. Demographic and outcomes data were collected, including ultimate diagnosis with serious condition, including central nervous system infection, trauma, intracranial mass, or stroke.
Results:
A total of 17,865 encounters from 36 children's hospitals were included for analysis. The mean age of participants was 1.89 years, 0.3% were coded as having status epilepticus, and 4.7% were admitted to the pediatric intensive care unit. The percentages of children admitted and receiving neuroimaging, labs, lumbar puncture, or EEG decreased over time, while drug screens and HSV testing increased. Fewer children received antiseizure medications, antibiotics, or acyclovir across the time periods. Median length of stay decreased in period 3 relative to period 1 (1.33 vs. 1.55 days). New serious diagnosis after presentation remained low at 0.2%. There was significant variation in resource use across hospitals.
Conclusion:
Resource use for CFS decreased across most domains since 2009 without an increase in serious medical diagnoses. These findings highlight a potential opportunity to standardize resource use when managing CFS.
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