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Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross‐sectional, Observational Study
Author(s) -
Guedj Romain,
Chappuy Hélène,
Titomanlio Luigi,
Trieu ThanhVan,
Biscardi Sandra,
NissackObiketeki Gisèle,
Pellegrino Béatrice,
Charara Oussama,
Angoulvant François,
Villemeur Thierry Billette De,
Levy Corinne,
Cohen Robert,
Armengaud Jean Baptiste,
Carbajal Ricardo
Publication year - 2015
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12798
Subject(s) - medicine , bacterial meningitis , meningitis , pediatrics , lumbar puncture , retrospective cohort study , confidence interval , febrile seizure , observational study , emergency department , epilepsy , cerebrospinal fluid , psychiatry
Objectives National and international guidelines are very heterogeneous about the necessity to perform a lumbar puncture ( LP ) in children under 12 months of age with a first simple febrile seizure. We estimated the risk of bacterial meningitis in children aged 6 to 11 months with a first simple febrile seizure. Methods This multicenter retrospective study was conducted in seven pediatric emergency departments ( ED s) in the region of Paris, France. Visits of patients aged 6 to 11 months for a first simple febrile seizure from January 2007 to December 2011 were analyzed. Bacterial meningitis was sequentially sought for by 1) analyzing bacteriologic data at the time of the visit, 2) looking for data from a second visit to the hospital after the index visit, and 3) phone calling the child's parents to determine the symptom evolution after the index visit. Infants lost to this follow‐up were searched for in a national bacterial meningitis database. Results From a total of 1,183,487 visits in the seven pediatric ED s, 116,503 were for children 6 to 11 months of age. From these, 205 visits were for a first simple febrile seizure. An LP was performed in 61 patients (29.8%). The outcome bacterial meningitis was ascertainable for 168 (82%) visits. No bacterial meningitis was found among these patients (95% confidence interval = 0% to 2.2%). None of the 37 infants lost to our follow‐up were registered in the national database as having bacterial meningitis. Conclusions Among children between 6 and 11 months of age with a first simple febrile seizure, the risk of bacterial meningitis is extremely low. These results should encourage national and international societies to either develop or endorse guidelines limiting routine LP in these infants and contribute to widely homogenized management practices.