If by "febrile child presenting with seizure" you mean a simple "febrile
seizure," then the AAP guidelines published in Pediatrics (1996;97:773-775)
suggest that you "consider" an LP for kids 12-18mo, and "strongly consider"
an LP for kids under a year. Even though the risk of meningitis is
extremely low, these recommendations were meant to be used by a wide variety
of practitioners, with different levels of comfort evaluating kids, so they
are very conservative.
We are in the process of studying about 500 kids who have presented with
first time simple febrile sz to 7 different ED's in the Chicago area. It
turns out that the liklihood of getting an LP depends less on the patient's
age and more on where the patient is seen. Patients presenting to smaller,
community hospitals are more likely to get an extensive evaluation (i.e. LP,
electrolytes, admission, EEG etc.), while those presenting to a pediatric ED
or a large general ED are more likely to have no work up at all.
(Incidently, we have found no cases of meningitis among these 500 patients).
All of the kids in our study met strict criteria for simple febrile seizure
(i.e. GTCSz lasting <15min in a febrile child 6mo-5yrs, with normal neuro
exam). There are no guidelines for the w/u of atypical febrile sz, or for
kids who otherwise look ill, although the paper by Green & Rothrock
(Pediatrics 1993;92:527) suggests that seizure is very unlikely to be the
only manifestation of bacterial meningitis.
Hope this helps,
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