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steven szabo wrote:
>
> Just one last thought on this issue....maybe I am a little slow but I never
> realy got it: what is the statistical chance of a second febrile seizure (
> 6 month later) not being caused by bacterial infection and /or meningitis......
 
Approximately one-third of children with first SIMPLE febrile sz will have a
second with subsequent febrile illness and 50% of these will have a third
event. 50% of recurrances happen within 6 months, an additional 25% within 1
year and 90% within 2 years.
 
Lastly.. all the algorithims and practice variances re LP/no LP in febrile sz
and differences in management underscores a concerted effort to diagnose a
relatively rare (albeit devastating)occult illness (meningitis
viral/bacterial)amongst a relatively more common event (febrile sz). Wether it
is history and clinical appearence only , rigorous algorithims or unforgiving
practice standards, the purpose is the same. Why do we bother with all
this...missing it could have life threatening/altering consequences for our
patient and like it or not medical legal consequences for us as practitioners.
I have little doubt that the subscribers to this list are able to utilize
their talents to meet the challenge and highly facile with the procedures
involved. The real challenge is to get our less experienced colleagues who
serve at risk populations or have minimal contact with sick children to
appreciate the nuances. We spend millions to hospitalize the R/O MI for 24-72
hrs to find the real MI's---why should we do less for children when the r/o
can be done quicker and cheaper???
 
 
Jeffrey Proudfoot,D.O.
PEM Fellow
Maricopa Medical Center
Phoenix, AZ
 
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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html