Practice Based Learning: Are lumbar punctures indicated in first time seizures of febrile, older children?

Becca Philipsborn, MD

Presented by Becca Philipsborn, MD

Key Points:

  • It depends case by case
  • Patients with bacterial meningitis usually present with findings other than seizure and fever
  • There is a paucity of data on fever with seizures in older children and adults
  • It is reasonable to strongly consider LP on a patient with new onset seizure, fever, and any concern for meningitis (i.e. headache)
  • The bacterial meningitis score is useful deciding whether or not to start antibiotics in older children
  • Case presented stresses the importance of adapting to unfolding clinical scenario


Children’s Healthcare of Atlanta – Emergency Department. First time seizure management guidelines. 2012.

Green SM, Rothrock SG, Clem KJ, et al. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993 Oct;92(4):527-34. PubMed PMID: 8414822.

Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology. 2000 Sep 12;55(5):616-23. PubMed PMID: 10980722.

Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA. 2007 Jan 3;297(1):52-60. PubMed PMID: 17200475.

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