Which children with febrile seizures need lumbar puncture? A decision analysis approach.
Whether all children brought to the emergency room with a first seizure and fever require lumbar puncture (LP) remains controversial. We reviewed the emergency room records of 241 children aged 6 months to 6 years who had this clinical picture. Five history and physical examination items discriminated between children with and without meningitis: a physician visit within 48 hours before the seizure; the occurrence of convulsions on arrival at the emergency room; a focal seizure; suspicious findings on physical and/or neurologic examination. Used in combination, these items (risk factors) identified all children with meningitis but would have spared 62% of children without meningitis the need for LP. In a decision analysis framework, they were as sensitive but more specific than LP in detecting children with meningitis. Most important, their negative predictive value was 100%.
D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005189:False Positive Reactions; D006801:Humans; D007223:Infant; D008297:Male; D008487:Medical History Taking; D008581:Meningitis / Q000175:diagnosis*; D009460:Neurologic Examination; D010808:Physical Examination; D012306:Risk; D003294:Seizures, Febrile / Q000175:diagnosis* / Q000601:surgery; D013129:Spinal Puncture