I teach our residents that you are obligated to do an LP in a patient
with a febrile seizure unless they are 99% certain that they do not have
meningitis. This has two implications.
The first is that there are no other firm guidelines. Older children
are easier to evaluate so it is easier for me to reach my 99% confidence
threshold. But there are 9-month-olds who are happy cooing and smiling
after a febrile seizure - they do not need an LP even though they are
young. Likewise having had previous febrile seizures does not protect
you from meningitis so whether or not this is the first episode
The second is I may reach 99% confidence at a different point than you
do because of experience or other factors. So you may tap I kid I wopuld
not and we could both be right.
David F. Soglin, M.D.
Chairman, Division of Pediatric Emergency Medicine
Cook County Children's Hospital
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