title: Epidemiology and diagnostic and therapeutic management of febrile seizures in the Italian pediatric emergency departments: A prospective observational study.
abstract: Febrile seizures (FS) involve 2-5% of the paediatric population, among which Complex FS (CFS) account for one third of accesses for FS in Emergency Departments (EDs). The aim of our study was to define the epidemiology, the clinical, diagnostic and therapeutic approach to FS and CFSs in the Italian EDs.
  
  
  
  A multicenter prospective observational study was performed between April 2014 and March 2015. Patients between 1 and 60 months of age, randomly accessing to ED for ongoing FS or reported FS at home were included. Demographic features and diagnostic-therapeutic follow-up were recorded. FS were categorized in simple (<10min), prolonged (10-30min) and status epilepticus (>30min).
  
  
  
  The study population consisted of 268 children. Most of the children experienced simple FS (71.65%). Among the 68 (25.37%) patients with complex FS, 11 were 6-12 month-old, accounting for 45.83% of all the infants with FS in the younger age group. No therapy has been administered at home in 76.12% patients; 23.51% of them received endorectal diazepam and only 1 patient received buccal midazolam. At arrival at ED, no therapy was necessary for 70.52% patients; 50.63% received endorectal diazepam and 17.72% an i.v. bolus of midazolam. Blood tests and acid-base balanced were performed respectively in 82.09% of cases. An electroencephalogram at ED was performed in 21.64% of patients. Neuroimagings were done in 3.73% of cases. A neurologic consultation was asked for 36 patients (13.43%).
  
  
  
  this is the first study assessing epidemiologic characteristics of FS in the Italian pediatric population, evidencing a higher prevalence of CFSs in children younger than 12 months of age and opening a new research scenario on the blood brain barrier vulnerability. On a national level, our study showed the need for a diagnostic standardized work-up to improve the cost/benefit ratio on CFS management.
authors.affiliation: General and Emergency Paediatrics Operative Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Italy. Electronic address: giovitaliti@yahoo.it.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Vitaliti
authors.affiliation: Pediatric Emergency Operative Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Castagno
authors.affiliation: Unit of Epidemiology, Regional Health Service, ASL TO3, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ricceri
authors.affiliation: Pediatric Emergency Operative Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Urbino
authors.affiliation: Clinical Paediatric, University of Perugia, Hospital SM della Misericordia, Perugia, Italy.
authors.forename: Alberto Verrotti
authors.initials: AV
authors.lastname: Di Pianella
authors.affiliation: Paediatric Nephrology Operative Unit, La Sapienza University of Rome, Rome Italy, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lubrano
authors.affiliation: Department of Paediatrics, Policlinico University Hospital of Modena, Modena, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Caramaschi
authors.affiliation: General Paediatrics Operative Unit, Sant'Eugenio Hospital, Rome Italy, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Prota
authors.affiliation: General Paediatric Operative Unit, Bolognini of Seriate Hospital, Bergamo, Italy.
authors.forename: Rita Maria
authors.initials: RM
authors.lastname: Pulvirenti
authors.affiliation: General Paediatric Operative Unit, V. Cervello Hospital, Palermo, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ajovalasit
authors.affiliation: Paediatric Complex Operative Unit, Maria Vittoria Hospital, Torino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Signorile
authors.affiliation: General Paediatrics and Neonatal Operative Unit, Santa Corona Hospital, Pietra Ligure, Savona, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Navone
authors.affiliation: General Paediatrics and Neonatal Complex Operative Unit, Vittorio Emanuele II Hospital, Castelvetrano, Trapani, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: La Bianca
authors.affiliation: Department of Pediatric, Bambino Gesù Children's Hospital, Pediatric and Infectious Diseases Unit, IRCCS, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
authors.affiliation: Department of Sciences for Health Promotion and Mother and Child Care, Pediatric Unit, University of Palermo, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corsello
authors.affiliation: General and Emergency Paediatrics Operative Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Falsaperla
mesh_terms: D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D002675:Child, Preschool; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D003294:Seizures, Febrile / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
chemical_list: D000927:Anticonvulsants
keywords: Emergency department; Epidemiologic study; Italian population; Pediatrics; Simple and complex febrile seizures