287 - Utility of Lumbar Puncture and Emergent Neuroimaging in Children With Complex Febrile Seizure
Thursday, May 14, 2020
1:00 PM – 1:08 PM
Location: Terrace: Terrace Level
Participants should be aware of the following financial/non-financial relationships:
Christine Saracino: No financial relationships or conflicts of interest
David Guernsey: No disclosure data submitted.
Tome Levy, DO: No financial relationships or conflicts of interest
Patricia Camino: No disclosure data submitted.
Shahfar Khan: No disclosure data submitted.
Lior Vardi: No disclosure data submitted.
Antonios Likourezos, MA, MPH: No disclosure data submitted.
Hector Vazquez: No disclosure data submitted.
Jefferson Drapkin, MPH: No disclosure data submitted.
Background and Objectives: Seizures are associated with both acute bacterial meningitis (ABM) and intracranial pathology, though the incidence of both of these outcomes is low in children presenting with complex febrile seizure (CFS). The objective of this study was to determine a set of predictors to distinguish those children who present with CFS who also have ABM or clinically important intracranial pathology from those who do not.
Methods: We performed a retrospective cohort study of all children age 6 months to 6 years who presented to a single urban pediatric emergency department between January 2009 and January 2019 with a complex febrile seizure. We excluded patients who had a previous history of non-febrile seizure, an underlying medical condition that predisposed the patient to seizure, a ventriculoperitoneal shunt, or known trauma. Data extracted from each patient’s electronic medical record (emr) included age, sex, ethnicity, fever height, presence or absence of focal neurologic deficit, nuchal rigidity, or altered mental status, seizure characteristics, cerebrospinal fluid (CSF) results (white blood cell count, red blood cell count, culture result), neuroimaging results, need for medical or neurosurgical intervention based on imaging results, and patient disposition.
Results: We identified 240 children with complex febrile seizure who met inclusion criteria. Forty-seven (19.6%) had a lumbar puncture (LP) performed and 53 (22.1%) had neuroimaging performed, either in the emergency department or during their inpatient stay related to this illness. Zero children were found to have ABM and two (0.8%) were found to have clinically important intracranial pathology. Both patients with clinically important intracranial pathology presented with multiple seizures in a twenty-four hour period.
Conclusion: The risk of both ABM and clinically important intracranial pathology in children with complex febrile seizure is low, indicating that routine lumbar puncture and emergent neuroimaging may not be necessary in this group of patients. However, more studies with a larger number of patients are needed to definitively make this determination.