Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?

Romain Guedj; Hélène Chappuy; Luigi Titomanlio; Loic De Pontual; Sandra Biscardi; Gisèle Nissack-Obiketeki; Béatrice Pellegrino; Oussama Charara; François Angoulvant; Julien Denis; Corinne Levy; Robert Cohen; Solène Loschi; Pierre Louis Leger; Ricardo Carbajal

doi:10.1016/j.annemergmed.2016.11.024

Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?

Ann Emerg Med. 2017 Jul;70(1):52-62.e6. doi: 10.1016/j.annemergmed.2016.11.024. Epub 2017 Mar 2.

Authors

Affiliations

¹ Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France. Electronic address: [email protected].
² Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.
³ Pediatric Emergency Department, Robert Debre Hospital, Paris, France.
⁴ Pediatric Department, Jean Verdier Hospital, Bondy, France.
⁵ Pediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
⁶ Pediatric Department, Lagny-Marne la vallée Hospital, Lagny-Sur-Marne Cedex, France.
⁷ Pediatric Emergency Department, Poissy Hospital, Poissy, France.
⁸ Pediatric Department, Versailles Hospital, Le Chesnay Cedex, France.
⁹ Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.
¹⁰ Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
¹¹ Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
¹² Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Neonatology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
¹³ Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
¹⁴ Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.

PMID: 28259480
DOI: 10.1016/j.annemergmed.2016.11.024

Abstract

Study objective: We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis.

Methods: This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex febrile seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents.

Results: From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex febrile seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]).

Conclusion: In children with a complex febrile seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex febrile seizure is not suggestive of meningitis or encephalitis.

Publication types

Multicenter Study

MeSH terms

Emergency Service, Hospital* / economics
Emergency Service, Hospital* / organization & administration
Encephalitis, Herpes Simplex / diagnosis*
Encephalitis, Herpes Simplex / epidemiology
Female
France
Humans
Infant
Male
Meningitis, Bacterial / diagnosis*
Meningitis, Bacterial / epidemiology
Practice Guidelines as Topic
Prevalence
Retrospective Studies
Seizures, Febrile / diagnosis*
Seizures, Febrile / epidemiology
Spinal Puncture / statistics & numerical data*
Unnecessary Procedures