title: Yield of emergent neuroimaging among children presenting with a first complex febrile seizure.
abstract: OBJECTIVE
  The objective of this study was to assess the risk of intracranial pathology requiring immediate intervention among children presenting with their first complex febrile seizure (CFS).
  
  
  METHODS
  This is a retrospective cohort review of patients 6 to 60 months of age evaluated in a pediatric emergency department between 1995 and 2008 for their first CFS. Cases were identified using computerized text search followed by manual chart review. We excluded patients with a prior history of a nonfebrile seizure disorder or a prior CFS, an immune-compromised state, an underlying illness associated with seizures or altered mental status, or trauma. Data extraction included age, sex, seizure features, prior simple febrile seizures, temperature, family history of seizures, vaccination status, findings on physical examination, laboratory and imaging studies, diagnosis, and disposition.
  
  
  RESULTS
  We identified a first CFS in 526 patients. Two hundred sixty-eight patients (50.4%) had emergent head imaging: 4 patients had a clinically significant finding: 2 had intracranial hemorrhage, 1 had acute disseminated encephalomyelitis, and 1 patient had focal cerebral edema (1.5%; 95% confidence interval, 0.5%-4.0%). Assigning low risk to patients not imaged and not returning to the emergency department within a week of the original visit, the risk of intracranial pathology in our sample was 4 (0.8%; 95% confidence interval, 0.2%-2.1%) of 526. Three of these 4 patients had other obvious findings (nystagmus, emesis, and altered mental status; persistent hemiparesis; bruises suggestive of inflicted injury).
  
  
  CONCLUSIONS
  Very few patients with CFSs have intracranial pathology in the absence of other signs or symptoms. Patients presenting with more than one seizure in 24 hours in particular are at very low risk.
authors.affiliation: Divisions of Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA. amir.kimia@childrens.harvard.edu
authors.forename: Amir A
authors.initials: AA
authors.lastname: Kimia
authors.forename: Elana
authors.initials: E
authors.lastname: Ben-Joseph
authors.forename: Sanjay
authors.initials: S
authors.lastname: Prabhu
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: Marvin
authors.initials: M
authors.lastname: Harper
mesh_terms: D002675:Child, Preschool; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059906:Neuroimaging / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000175:diagnosis*