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Ann Emerg Med. 2017 Jul;70(1):52-62.e6. doi: 10.1016/j.annemergmed.2016.11.024. Epub 2017 Mar 2.

Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?

Author information

1
Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France. Electronic address: romainguedj@gmail.com.
2
Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.
3
Pediatric Emergency Department, Robert Debre Hospital, Paris, France.
4
Pediatric Department, Jean Verdier Hospital, Bondy, France.
5
Pediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
6
Pediatric Department, Lagny-Marne la vallée Hospital, Lagny-Sur-Marne Cedex, France.
7
Pediatric Emergency Department, Poissy Hospital, Poissy, France.
8
Pediatric Department, Versailles Hospital, Le Chesnay Cedex, France.
9
Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.
10
Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
11
Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
12
Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Neonatology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
13
Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
14
Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.

Abstract

STUDY OBJECTIVE:

We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis.

METHODS:

This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex febrile seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents.

RESULTS:

From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex febrile seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]).

CONCLUSION:

In children with a complex febrile seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex febrile seizure is not suggestive of meningitis or encephalitis.

[Indexed for MEDLINE]

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