title: Lumbar puncture in children from an area of malaria endemicity who present with a febrile seizure.
abstract: 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.
authors.affiliation: Papua New Guinea Institute of Medical Research, Modilon General Hospital, Madang, Papua New Guinea.
authors.forename: Moses
authors.initials: M
authors.lastname: Laman
authors.forename: Laurens
authors.initials: L
authors.lastname: Manning
authors.forename: Ilomo
authors.initials: I
authors.lastname: Hwaiwhange
authors.forename: John
authors.initials: J
authors.lastname: Vince
authors.forename: Susan
authors.initials: S
authors.lastname: Aipit
authors.forename: Trevor
authors.initials: T
authors.lastname: Mare
authors.forename: Jonathan
authors.initials: J
authors.lastname: Warrel
authors.forename: Harin
authors.initials: H
authors.lastname: Karunajeewa
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: 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