Lumbar puncture in children from an area of malaria endemicity who present with a febrile seizure.
BACKGROUND
Although routine lumbar puncture (LP) is often recommended as part of the assessment of fever-associated seizures in children, accumulating evidence questions its value and reveals a decrease in its frequency. Our primary hypothesis was that children who present with a single seizure but with no clinical signs of meningism or coma do not require LP as part of initial diagnostic assessment.


METHODS
We prospectively followed up 377 children aged 2 months through 10 years who presented with at least 1 fever-associated seizure to Modilon Hospital, Madang, Papua New Guinea, from November 2007 through July 2009. Clinical management was performed by hospital staff according to national pediatric guidelines.


RESULTS
Of 188 children with a single seizure and 189 children with multiple seizures, 139 (73.9%) and 154 (81.5%), respectively, underwent a LP as part of their initial assessment. Of the 130 children with a single seizure but no evidence of meningism (ie, neck stiffness, positive Kernig's or Brudzinski's sign, and bulging fontanelle) or coma (Blantyre Coma Score 2), none (95% confidence interval, 0%-3.6%) had proven or probable acute bacterial meningitis, and only 1 patient had viral encephalitis (subacute sclerosing panencephalitis). Eighty-one of these children (62.3%) had a final diagnosis of a simple febrile seizure. Proven or probable acute bacterial meningitis was more common in children with a single seizure and meningism or coma (10; 17.2%) and in those with multiple seizures without or with meningism or coma (2 [2.0%] and 30 [33.7%], respectively).


CONCLUSIONS
Initial LP is unnecessary when careful clinical assessment indicates features of a simple febrile seizure.
Laman
Moses
M
Papua New Guinea Institute of Medical Research, Modilon General Hospital, Madang, Papua New Guinea.
Manning
Laurens
L
Hwaiwhange
Ilomo
I
Vince
John
J
Aipit
Susan
S
Mare
Trevor
T
Warrel
Jonathan
J
Karunajeewa
Harin
H
Siba
Peter
P
Mueller
Ivo
I
Davis
Timothy M E
TM
D002648:Child; D002675:Child, Preschool; D018792:Encephalitis, Viral / Q000175:diagnosis; D019353:Endemic Diseases; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications* / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis; D010219:Papua New Guinea / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D003294:Seizures, Febrile / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology; D013129:Spinal Puncture