According to the results published in Pediatrics, children with simple febrile seizures (SFS) can be treated without a lumbar puncture (LP).
With Haemophilus influenzae and conjugated pneumococcal vaccines, the prevalence of bacterial meningitis in pediatric patients has decreased dramatically. In 2011, the American Academy of Pediatrics (AAP) began advising doctors not to perform routine LP in children under 1 year of age and only use it in children with signs and symptoms of meningitis who are not fully vaccinated or have been previously treated with antibiotics . The AAP also advised against routine haematological testing, neuroimaging, or electroencephalography (EEG).
The aim of the current study was to analyze the impact of this change in practice guidelines on the clinical management of SFS in children in emergency rooms in children’s hospitals in the United States.
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The researchers analyzed data from the Pediatric Health Information System (PHIS) from data from 49 nonprofit children’s tertiary care hospitals affiliated with the Children’s Hospital Association. They included the first visits to the emergency room between 2015 and 2019 of children 6 to 60 months of age diagnosed with SFS. They excluded patients who died during the ED encounter and those with pre-existing complex chronic diseases. Delayed diagnosis of bacterial meningitis was defined as a re-visit diagnosis within 3 days of an index encounter without LP.
The researchers identified 49,668 visits before and 92,453 visits after the publication of the AAP guidelines. The median age of the patients (42.4% women) at presentation was 20.8 months.
The proportion of children who received an LP decreased from 11.6% in 2005 to 0.6% in 2019 (P <0.001), especially among children aged 6 to under 12 months (28.3% to 1.0%). The proportion of children aged 1 to 5 who received the procedure decreased from 9.4% in 2005 to 0.6% in 2019.
While 3-day repetitions increased from 0.5% in 2005 to 1.4% in 2019, computed tomography (CT) scans of the head (10.6% in 2005; 1.6% in 2019) and blood count (38.8% in 2005; 10.9% in 2019), serum chemistry (27.5% in 2005; 11.0% in 2019), and urinalysis (31.4% in 2019) 2005; 22.3% in 2019), intravenous antibiotics (17.7% in 2005; 3.3% in 2019) and SFS (19.2% in) 2005; 5.2% in 2019) over the period (P <0.001 for all) was not reversed with the change in the AAP guideline from 2011.
Taking healthcare inflation into account, the researchers found that the average inflation-adjusted cost decreased from $ 1,523 in 2005 to $ 605 in 2019 (P <0.001).
Declines in hospital admissions and costs stabilized under the 2011 AAP guidelines. The rate of delayed diagnosis of bacterial meningitis did not decrease significantly over the period.
Limitations of the study included lack of knowledge of the occurrence of signs and symptoms, inability to exclude underimmunized children, uncertainty as to whether patients had previous febrile seizures outside of facilities or time period, and identification by the SFS code.
“Diagnostic tests, hospital admissions and costs decreased over the study period without increasing the delayed diagnosis of bacterial meningitis. These data suggest that most children with SFS can be treated safely without a lumbar puncture or other diagnostic tests, ”the researchers concluded.
relation
Raghavan VR, Porter JJ, Neuman MI, et al. Trends in the treatment of simple febrile seizures in US children’s hospitals. Pediatrics. November 1, 2021. doi: 10.1542 / peds.2021-051517
