Presented by Palen Mallory, MD
- Predictors of meningitis in a child with complex febrile seizure include:
- Seizure lasting greater than 30 minutes
- Prolonged post-ictal drowsiness
- Abnormal neurologic exam
- In a well-appearing child with first complex febrile seizure, lumbar puncture is not indicated unless the child presents in status epilepticus
- In a well-appearing child with first complex febrile seizure, emergent neuroimaging is not indicated unless there are physical exam findings suggestive of a bleed or a mass
For the majority of children presenting to the Emergency Department with a first complex febrile seizure, lumbar puncture and neuroimaging are not indicated. These interventions should only be sought if the child is ill-appearing, presenting in status epilepticus, or has an abnormal neurologic exam.
Batra, P. et al. (2011). Predictors of meningitis in children presenting with first febrile seizures. Pediatric Neurology, 44(1), 35-39.
Fletcher, E., & Sharieff, G. (2013). Necessity of lumbar puncture in patients presenting with new onset complex febrile seizures. Western Journal of Emergency Medicine.
Hardasmalani, M., & Saber, M. (2012). Yield of diagnostic studies in children presenting with complex febrile seizures. Pediatric Emergency Care, 28(8), 789-791.
Kimia, A. et al. (2012). Yield of emergent neuroimaging among children presenting with a first complex febrile seizure. Pediatric Emergency Care, 28(4), 316-321.
Kimia, A. (2010). Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics, 126, 62-69.
Sales, J., Bulloch, B., & Hostetler, M. (2011). Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows. Canadian Journal of Emergency Medicine, 13(3), 145-149.
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