Just a few comments since the issues of GABHS and febrile seizures have been
so finely discussed over the last week:
1. The "Febrile Seizure" practice parameters were written and published by the
AAP - not ACEP. The widely discussed and debated Fever Guidelines were
written by a Consensus Panel - not AAP or ACEP. ACEP has Guidelines for the
management of the febrile child but they are are fairly general and
incorporated in our practice anyway. (There was the comment - <<"The
guidelines from the AAP and the ACEP are just guidelines and I hope to
God they will stop publishing them.
I'm just tired of these so called guidelines which may cause unnecessary
risks to kids and is a financial burden for some parents.">>)
2. This is not to say that ACEP was not or should not have been involved in
developing the Febrile Seizure Parameter. It wasn't asked. However, several
members from ACEP and the AAP Section on PEM reviewed the Febrile Seizure
document and were instrumental in getting the wording changed so that we are
less obligated to perform LPs. As most of us would agree on this thread, we
are happy that the wording was softened to allow for physician judgment -
"Strongly considered" was changed to "consider", etc with the different age
3. I actually like the "Febrile seizure" document - I quote it frequently when
asked to do "CBCs or lytes" by practitioners who haven't seen the patient.
The Febrile Seizure document recommends: No CBC, no lytes, no EEG, no CT, and
no LP. It has been of great assistance in trying to get the PCPs to lighten
up on the work-ups. It actually saves children from getting unnecessary
Now, if the folks on this List-serve would write some practice parameters and
guidelines rather than insurance companies, hospitals, state Depts. of Health,
etc - then we would really be onto something.
Have a good week.
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