Katherine Bakes, MD reviewing Guedj R et al. Acad Emerg Med 2015 Nov
Pediatric practice guidelines vary on the routine use of lumbar puncture for evaluation of possible bacterial meningitis in children presenting to emergency departments with febrile seizure.
In a multicenter, retrospective study, investigators estimated the risk for bacterial meningitis in children aged 6 to 11 months presenting with a first-time, simple febrile seizure — defined as a generalized seizure lasting <15 minutes that did not recur within 24 hours — to one of seven pediatric emergency departments in France. Patients were excluded if they had a history of seizure, conditions predisposing to seizure, an immunocompromised state, or signs of meningitis (e.g., irritability, neck stiffness, purpura, hypotonia, bulging fontanel).
Of 205 children presenting with febrile seizure between 2007 and 2011, 61 (30%) underwent lumbar puncture, 11 of whom had cerebrospinal fluid pleocytosis (>4 white blood cells/mm3) but no bacterial growth. No cases of bacterial meningitis were identified either by cerebrospinal fluid testing or at follow-up, and among those lost to follow-up, none were registered in a national database of bacterial meningitis cases.
Consistent with the American Academy of Pediatrics guideline, lumbar puncture is not routinely recommended in vaccinated children aged 6 to 12 months with simple febrile seizures. Lumbar puncture should be considered for those with predisposing conditions, signs of meningitis, persistent altered mental status, incomplete vaccinations, or ill appearance.
Guedj R et al. Risk of bacterial meningitis in children 6 to 11 months of age with a first simple febrile seizure: A retrospective, crosssectional, observational study. Acad Emerg Med 2015 Nov; 22:1290. (http://dx.doi.org/10.1111/acem.12798) PubMed abstract (Free)