title: Yield of lumbar puncture among children who present with their first complex febrile seizure.
abstract: OBJECTIVE
  To assess the rate of acute bacterial meningitis (ABM) among children who present with their first complex febrile seizure (CFS).
  
  
  METHODS
  This study was a retrospective, cohort review of patients aged 6 to 60 months who were evaluated in a pediatric emergency department (ED) between 1995 and 2008 for their first CFS. Cases were identified by using a computerized text search followed by a manual chart review. Exclusion criteria included prior history of nonfebrile seizures, an immunocompromised state, an underlying illness associated with seizures or altered mental status, or trauma. Data extracted included age, gender, seizure features, the number of previous simple febrile seizures, temperature, a family history of seizures, findings on physical examination, laboratory and imaging study results, and ED diagnosis and disposition.
  
  
  RESULTS
  We identified 526 patients. The median age was 17 months (interquartile range: 13-24), and 44% were female. Ninety patients (17%) had a previous history of simple febrile seizures. Of the patients, 340 (64%) had a lumbar puncture (LP). The patients' median white blood cell count during a CFS was 1 cell per microL (interquartile range: 1-2), and 14 patients had CSF pleocytosis (2.7% [95% confidence interval [CI]: 1.5-4.5]). Three patients had ABM (0.9% [95% CI: 0.2-2.8]). Two had Streptococcus pneumoniae in a culture of their cerebrospinal fluid. Among these 2 patients, 1 was nonresponsive during presentation, and the other had a bulging fontanel and apnea. The third child appeared well; however, her blood culture grew S pneumoniae and failed the LP test. None of the patients for whom an LP was not attempted subsequently returned to the hospital with a diagnosis of ABM (0% [95% CI: 0, 0.9]).
  
  
  CONCLUSIONS
  Few patients who experienced a CFS had ABM in the absence of other signs or symptoms.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA. amir.kimia@childrens.harvard.edu
authors.forename: Amir
authors.initials: A
authors.lastname: Kimia
authors.forename: Elana Pearl
authors.initials: EP
authors.lastname: Ben-Joseph
authors.forename: Tiffany
authors.initials: T
authors.lastname: Rudloe
authors.forename: Andrew
authors.initials: A
authors.lastname: Capraro
authors.forename: Dean
authors.initials: D
authors.lastname: Sarco
authors.forename: David
authors.initials: D
authors.lastname: Hummel
authors.forename: Patrick
authors.initials: P
authors.lastname: Johnston
authors.forename: Marvin B
authors.initials: MB
authors.lastname: Harper
mesh_terms: D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001774:Blood Chemical Analysis; D002555:Cerebrospinal Fluid / Q000166:cytology*; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D003294:Seizures, Febrile / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D013129:Spinal Puncture / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants