Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 6-12 (doi:10.1542/peds.2007-3424)
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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.


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eLetters:

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