title: Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?
abstract: OBJECTIVE
  We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis.
  
  
  METHODS
  This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex febrile seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents.
  
  
  RESULTS
  From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex febrile seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]).
  
  
  CONCLUSIONS
  In children with a complex febrile seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex febrile seizure is not suggestive of meningitis or encephalitis.
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France. Electronic address: romainguedj@gmail.com.
authors.forename: Romain
authors.initials: R
authors.lastname: Guedj
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Chappuy
authors.affiliation: Pediatric Emergency Department, Robert Debre Hospital, Paris, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
authors.affiliation: Pediatric Department, Jean Verdier Hospital, Bondy, France.
authors.forename: Loic
authors.initials: L
authors.lastname: De Pontual
authors.affiliation: Pediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Biscardi
authors.affiliation: Pediatric Department, Lagny-Marne la vallée Hospital, Lagny-Sur-Marne Cedex, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Nissack-Obiketeki
authors.affiliation: Pediatric Emergency Department, Poissy Hospital, Poissy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Pellegrino
authors.affiliation: Pediatric Department, Versailles Hospital, Le Chesnay Cedex, France.
authors.forename: Oussama
authors.initials: O
authors.lastname: Charara
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Angoulvant
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Denis
authors.affiliation: Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Levy
authors.affiliation: Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Neonatology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Loschi
authors.affiliation: Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France.
authors.forename: Pierre Louis
authors.initials: PL
authors.lastname: Leger
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
mesh_terms: D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000175:diagnosis* / Q000453:epidemiology; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures