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Seizure. 2019 Apr;67:52-56. doi: 10.1016/j.seizure.2019.03.007. Epub 2019 Mar 15.

Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure.

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Department of Epidemiology, UCLA Fielding School of Public Health, LA, CA, USA; Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan. Electronic address:
Division of Neurology, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
Division of Pediatric Neurology, Department of Pediatrics, UCLA Medical Center, LA, CA, USA.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Japan.


Purpose This study investigated clinical practice patterns for admissions due to FS at a national level. Method Discharge records were extracted for patients with FS aged < 6 years for the years 2010-16 using national inpatient database in Japan. We ascertained antiepileptic drug use, diagnostic procedures, healthcare costs, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. We also investigated correlations between performance of lumbar puncture (LP), and use of head computed tomography (CT) and antibiotics. Results We identified a total of 94,452 eligible patients. Hospitalization costs and LOS in days decreased from 19,027 JPY and 4.6 days in 2010 to 18,753 JPY and 4.1 days in 2016. Phenytoin use decreased from 1.6% in 2010 to 0.5% in 2016, whereas fosphenytoin use increased from 0% in 2010 to 6.7% in 2016. Decreasing trends were observed in CT use (from 32.8% to 16.9%) and LP performance (16.9% to 13.5%). For the analyses at hospital levels, CT use and LP performance was positively correlated (r = 0.63). No correlations were observed between total and extremely broad-spectrum antibiotic use and CT use or LP performance in hospitals without cases of intensive care. Wide variations were observed across hospitals for performance of LP (0%-88%), use of CT (0%-84%) and antibiotics (10%-99%). Conclusion We provided novel insights into the current practice patterns for children with FS at individual levels, and delineated wide variations of LP, CT, and antibiotic use for the practices at hospital levels.


Anticonvulsants; Antimicrobial stewardship; Practice pattern; febrile seizure

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