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Should We LP Children With Complex Febrile Seizure?

June 1, 2018

Written by Clay Smith

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Lumbar puncture (LP) is low-yield in children with complex febrile seizure (CFS).  Use caution if unvaccinated or pretreated with antibiotics.

Why does this matter?
In the era of Hib and pneumococcal vaccines, the AAP no longer recommends LP in vaccinated children with simple febrile seizure.  A study by Kimia et al in 2010 found that LP for CFS was also very low-yield.  At that time, 64% of the children in the study had LP performed.  What are current practice patterns?

This is complex
This was a retrospective look at national data, with 28,810 children from the US between 2007-2014, regarding performance of LP for CFS.  The rate of LP fell from 2007 to 2014, from 31 to 18%.  Out of the group, 25.8% had LP performed; 80 had “CNS infection” (0.3% = 80/28,810).  The database did not record what type of CNS infection, whether viral or bacterial.  In the absence of guidelines for the management of CFS, this gives us more evidence that LP is generally unhelpful.  But watch out if children are unvaccinated, undervaccinated, or are pretreated with antibiotics.  Also, LP is warranted in children with CFS who have persistent altered mental status, are ill-appearing, apneic, have bulging fontanelle, or other worrisome signs of CNS infection.

Complex Febrile Seizures, Lumbar Puncture, and Central Nervous System Infections: a National Perspective.  Acad Emerg Med. 2018 Apr 27. doi: 10.1111/acem.13441. [Epub ahead of print]

Reviewed by Thomas Davis