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Seizures associated with fever: clinical data as predictors for normal biochemical blood levels
M van Stuijvenberg1, E N van Gijssel, E W Steyerberg
1Department of Paediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands. vanstuijvenberg@alkg.azr.nl
Insights
Biochemical blood tests are rarely abnormal in children with febrile seizures. A new predictive model helps determine if these tests are necessary, reducing unnecessary procedures for pediatric patients.
Area of Science:
- Pediatrics
- Clinical Chemistry
- Epidemiology
Background:
- Febrile seizures are common in children.
- Biochemical blood tests are often performed to assess electrolyte and glucose levels.
- Predictive models can aid in clinical decision-making.
Purpose of the Study:
- To develop and validate a predictive model for normal biochemical blood test results in children with febrile seizures.
- To identify clinical characteristics that predict the likelihood of abnormal test results.
- To reduce unnecessary biochemical testing in pediatric patients.
Main Methods:
- Logistic regression analysis was used to develop predictive models.
- Patient history and physical examination data from 203 children were analyzed.
- Model performance was evaluated using the area under the receiver operating characteristic curve.
Main Results:
- Abnormal biochemical blood test results (sodium, calcium, glucose) were infrequent and not clinically significant.
- The predictive models demonstrated moderate discriminative ability (AUC 0.63-0.66).
- A score chart was developed to assist in determining the need for biochemical testing.
Conclusions:
- Biochemical blood tests are generally not required in children presenting with seizures associated with fever.
- The developed score chart can help clinicians decide on the necessity of biochemical testing.
- Unnecessary testing can be avoided, especially in cases with a low probability of abnormal results.
Unlabelled:
We developed a predictive model to assess the probability of normal biochemical blood test results in children presenting with a seizure associated with fever. The models were based on various combinations of patient characteristics of the history and physical examination of 203 children. The characteristics included gender, age in years, previous history of febrile seizures, family history of febrile seizures, fever previous to the seizure, vomiting and diarrhoea previous to the seizure. Further, clinical characteristics of the seizure were considered: focal seizure signs, multiple seizure, seizure duration and rectal temperature at seizure. The outcome was defined as normal test results of serum levels of sodium (n=115, 68%), calcium (n=149, 89%) and glucose (n=173, 100%), according to the hospital reference values. The prevalence of abnormal test results was rather low and the abnormalities were outside the morbidity range. We used logistic regression to relate the outcome to the several clinical characteristics. The discriminative ability of the models was 0.63 (area under the receiver operating characteristic curve of the model predicting normal sodium), 0.66 (normal calcium) and 0.66 (both normal). The score chart we constructed is an additional tool to a carefully performed patient history and physical examination and it may help to decide if a biochemical test is indicated for the individual patient.
Conclusion:
In children with seizures associated with fever, abnormal biochemical blood test results are rare and outside the morbidity range. The biochemical tests are generally not required. In children with a low probability of a normal result as calculated by the score chart, the test may be indicated.