Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 304-308 (doi:10.1542/peds.2005-0759)

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Risk of Intracranial Pathologic Conditions Requiring Emergency Intervention After a First Complex Febrile Seizure Episode Among Children

David Teng, MD^a, Peter Dayan, MD, MSc^a, Sarah Tyler, BA^b, W. Allen Hauser, MD^c,d,e, Stephen Chan, MD^f, Linda Leary, MD^a,c and Dale Hesdorffer, PhD^d,e

^a Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York
^b Duke University School of Medicine, Durham, North Carolina
^c Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York
^d Gertrude H. Sergievsky Center, Columbia University, New York, New York
^e Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
^f Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York

OBJECTIVE. To determine the likelihood of intracranial pathologic conditions requiring emergency neurosurgical or medical intervention among children without meningitis who presented to the pediatric emergency department after a first complex febrile seizure.

METHODS. We performed a retrospective review of prospectively collected data for children in neurologically normal condition who presented to a single pediatric emergency department after a first complex febrile seizure (focal, multiple, or prolonged). The complex febrile seizure classification was determined independently by 2 epileptologists. The presence of intracranial pathologic conditions was determined through review of neuroimaging results, telephone interviews, or medical record review.

RESULTS. Data for 71 children with first complex febrile seizures were analyzed. Fifty-one (72%) had a single complex feature (20 focal, 22 multiple, and 9 prolonged), and 20 (28%) had multiple complex features. None of the 71 patients (1-sided 95% confidence interval: 4%) had intracranial pathologic conditions that required emergency neurosurgical or medical intervention.

CONCLUSIONS. For children with first complex febrile seizures, the risk of intracranial pathologic conditions that require emergency neurosurgical or medical intervention is low, which suggests that routine emergency neuroimaging for this population is unnecessary.

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Key Words: complex febrile seizures • neuroimaging • emergency intracranial pathology

Abbreviations: CT—computed tomographic • ED—emergency department

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Accepted May 25, 2005.

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