Guideline on Lumbar Puncture In Febrile Seizure to Be Relaxed

ACEP News
July 2010

NEW YORK -- The American Academy of Pediatrics is likely to drop its recommendation for lumbar puncture and culture in all children 6-18 months of age who present with a first, simple febrile seizure, according to the chair of the AAP committee considering the change.

The current recommendation, developed in 1996, is "in revision," said Dr. Paul G. Fisher, division chief of child neurology at Stanford (Calif.) University. The revised guideline "will probably be released later this year or early next year," he said.

Speaking at the American College of Emergency Physicians' Advanced Pediatric Emergency Medicine Assembly, Dr. Fisher said that a study published last year in Pediatrics gave a strong impetus to changing the existing guideline.

That retrospective cohort study, from researchers at Children's Hospital Boston, looked at all 71,234 infants who visited the hospital's pediatric ED from 1995 to 2006. The researchers assessed how closely the AAP guideline was being followed and how often lumbar punctures (LPs) proved positive for bacterial meningitis.

They found that simple febrile seizures accounted for 704 (1%) of all the visits. LPs were performed in 271 (38%) of these cases. Although the cerebrospinal fluid white blood cell count was elevated in 10 cases, no pathogen was identified in any culture, and no patient was diagnosed with bacterial meningitis (Pediatrics 2009;123:6-12).

The 1996 recommendation was developed before the introduction of 7-valent pneumococcal conjugate vaccine, Dr. Fisher noted. The revised guidelines will recommend LP in more narrowly delineated cases. In particular, Dr. Fisher said, "lumbar puncture should be performed in any child who presents with a seizure and a fever and has meningeal signs and symptoms, e.g. neck stiffness, Kernig and/or Brudzinski signs or in any child whose history or examination suggests intracranial infection."

--Dan Hurley

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