Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 6-12 (doi:10.1542/10.1542/peds.2007-3424)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kimia, A. A.
Right arrow Articles by Harper, M. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kimia, A. A.
Right arrow Articles by Harper, M. B.
Related Collections
Right arrow Infectious Disease & Immunity
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age

Amir A. Kimia, MD, Andrew J. Capraro, MD, David Hummel, MSc, Patrick Johnston, MMath and Marvin B. Harper, MD

Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts

OBJECTIVES. American Academy of Pediatrics consensus statement recommendations are to consider strongly for infants 6 to 12 months of age with a first simple febrile seizure and to consider for children 12 to 18 months of age with a first simple febrile seizure lumbar puncture for cerebrospinal fluid analysis. Our aims were to determine compliance with these recommendations and to assess the rate of bacterial meningitis detected among these children.

METHODS. A retrospective cohort review was performed for patients 6 to 18 months of age who were evaluated for first simple febrile seizure in a pediatric emergency department between October 1995 and October 2006.

RESULTS. First simple febrile seizure accounted for 1% of all emergency department visits for children of this age, with 704 cases among 71 234 eligible visits during the study period. Twenty-seven percent (n = 188) of first simple febrile seizure visits were for infants 6 to 12 months of age, and 73% (n = 516) were for infants 12 to 18 months of age. Lumbar puncture was performed for 38% of the children (n = 271). Samples were available for 70% of children 6 to 12 months of age (131 of 188 children) and 25% of children 12 to 18 months of age (129 of 516 children). Rates of lumbar puncture decreased significantly over time in both age groups. The cerebrospinal fluid white blood cell count was elevated in 10 cases (3.8%). No pathogen was identified in cerebrospinal fluid cultures. Ten cultures (3.8%) yielded a contaminant. No patient was diagnosed as having bacterial meningitis.

CONCLUSIONS. The risk of bacterial meningitis presenting as first simple febrile seizure at ages 6 to 18 months is very low. Current American Academy of Pediatrics recommendations should be reconsidered.

Key Words: febrile seizure • bacterial meningitis • lumbar puncture • consensus statement

Abbreviations: LP—lumbar puncture • AAP—American Academy of Pediatrics • CSF—cerebrospinal fluid • CI—confidence interval • ED—emergency department • FSFS—first simple febrile seizure • WBC—white blood cell

Accepted Mar 25, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 AAP Grand RoundsHome page
J. G. Millichap
Indications for LP Following 1st Febrile Seizure Reconsidered
AAP Grand Rounds, March 1, 2009; 21(3): 25 - 25.
[Full Text] [PDF]

Home page
 JWatch Emergency Med.Home page
LP Is Not Needed for Young Children with First Simple Febrile Seizure
Journal Watch Emergency Medicine, February 27, 2009; 2009(227): 1 - 1.
[Full Text]

Home page
 JWatch PediatricsHome page
Need for Lumbar Puncture in Children with Simple Febrile Seizure
Journal Watch Pediatrics and Adolescent Medicine, February 4, 2009; 2009(204): 3 - 3.
[Full Text]

eLetters:

Read all eLetters

Lumbar puncture is still necessary for any child with first simple febrile seizure
Huei-Shyong Wang
Pediatrics Online, 14 Jan 2009 [Full text]