Practice Based Learning: What workup needs to be done for a complex febrile seizure?

Palen Mallory, MD

Presented by Palen Mallory, MD

Key points:

  • 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

Bottom line:

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.

Teng, D. et al. (2006). Risk of intracranial pathologic condition requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics, 117, 304-308

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