NEW YORK (Reuters Health) – Few pediatric patients with complex febrile seizures have acute bacterial meningitis if other signs and symptoms are absent, clinicians at Children’s Hospital Boston, Massachusetts, have found. Therefore, they say, lumbar puncture should be reserved for cases where there is clinical suspicion and other signs suggesting meningitis.
Dr. Amir Kimia and colleagues conducted a retrospective study to assess the yield of lumbar puncture among 526 young children who were evaluated in the emergency department with at least one feature of complex febrile seizure (CFS): i.e., multiple seizures, laterality, or prolonged duration.
“The question is not whether patients with meningitis may present with seizures but, rather, whether there is a risk of bacterial meningitis among patients who present solely with a CFS,” the authors point out in their report in the July issue of Pediatrics.
In the cohort, 340 of the patients had a lumbar puncture. Three were diagnosed with acute bacterial meningitis, all with S. pneumoniae.
Two had clear signs suggesting meningitis; one, an 11-month-old boy, had a bulging fontanel and nuchal rigidity; the other, a 4-year-old boy, was nonresponsive during presentation. The third patient, a 7-month-old girl, appeared well despite two short generalized seizures in 24 hours. Her spinal fluid specimen was contaminated with blood and did not produce bacterial growth, but a blood culture was positive for S. pneumoniae. She was treated for suspected bacterial meningitis.
None of the children in whom lumbar puncture was not performed had a subsequent diagnosis of acute bacterial meningitis, at least not at the authors’ institution.
Summing up, the investigators write: “Because the clinical assessment of these children is rarely complicated by a prolonged postictal state or by sedation from anticonvulsive medication, and the identified risk is low, we concluded that LP should be reserved in this group to patients deemed clinically appropriate.”
In fact, they add, when the only feature of a CFS is two brief nonfocal seizures in 24 hours, the likelihood of acute bacterial meningitis is particularly low.
Reference:
Pediatrics 2010;126:62–69.
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