Children with First‐time Simple Febrile Seizures Are at Low Risk of Serious Bacterial Illness

Abstract

Abstract. Objective: To describe the rates of serious bacterial illness (SBI) in children presenting to emergency departments (EDs) with first-time uncomplicated febrile seizures. Methods: The ED visits from seven Chicago metropolitan area hospitals (two tertiary pediatric EDs, five community general EDs) for all pediatric patients seen between July 1995 and December 1997 with a discharge diagnosis including the term ''seizure'' were retrospectively identified. Records of patients who met criteria for simple, firsttime febrile seizure were reviewed (age 6-60 months; temperature Ն38.0ЊC; single, generalized, tonicclonic seizure <20 minutes; absence of known central nervous system disease). Rates of bacteremia, urinary tract infection, bacterial meningitis, and pneumonia were determined. Results: Four hundred fiftyfive children were identified who had first-time simple febrile seizures. The study participants had a mean age of 21 months and a mean temperature of 39.6ЊC, and 64% were male. Seventy-three percent were seen in a community hospital setting. Blood cultures were obtained for 315 children (69%). Four children (1.3% [95% CI = 0.1% to 2.5%]) were bacteremic, all with Streptococcus pneumoniae; the rate of bacteremia did not differ in the subset at highest risk for bacteremia (6-36 months, temperature >39ЊC). No demographic or laboratory data distinguished the bacteremic children from those with negative blood cultures. One hundred seventy-one children (38%) had urine cultures obtained; 5.9% [95% CI = 2.4% to 9.4%] of the cultures grew >100,000 colony-forming units/mL of a single pathogenic organism. One hundred thirty-five children (30%) had cerebrospinal fluid cultures performed. None of these cultures grew a bacterial pathogen [95% CI = 0% to 2.2%]. Two hundred eight children (45.7%) had chest x-rays performed; 12.5% [95% CI = 10.2% to 14.8%] (n = 26) of the x-rays were read as consistent with pneumonia by the radiologist at the treating institution. None of the blood cultures performed on children with abnormal radiographs were positive (cultures drawn on 23 of 26 patients, 88%). Stool cultures were performed on 14 children (3.1%); two cultures (14.3% [95% CI = 0% to 32.6%]) grew a bacterial pathogen, both Shigella. Conclusions: Rates of SBI in this multi-institution population of children with first-time simple febrile seizures were low and are consistent with those published in the literature for febrile children without seizures. Key words: febrile seizure; bacteremia; urinary tract infection; meningitis. ACA-DEMIC EMERGENCY MEDICINE 2001; 8:781-787 S IMPLE febrile seizures are the most common convulsive disorder of childhood and a frequent cause of visits to the emergency department (ED) in both community and tertiary care pediatric institutions. Historically, many emergency medicine providers feared that children who experienced a simple febrile seizure were more ''ill'' than equally febrile children without seizures and evaluated the children with simple febrile seizures more rigorously.1 Althoug...

Handwashing Practices in Neonatal Intensive Care Unit, Paediatric Intensive Care Unit and Neonatal Nurseries in Patan Hospital

“…World Health Organisation (WHO) 11 and Centre for Disease Control (CDC) 12 have introduced guidelines for proper handwashing by healthcare workers to improve handwashing practices and hence to minimise hospital acquired infections.…”

Risk of Bacterial Meningitis in Children With First-time Febrile Seizure

“…Bu nedenle geçmişten günümüze kadar, ateşli nöbet geçiren hastalarda ABM riskinin artıp artmadığı ve hangi durumlarda LP yapılması gerektiği çeşitli çalışmalara konu olmuştur (7)(8)(9)(10)(11)(12)(13).…”

“…Ateşli nöbetin bakteriyel menenjitin sık karşılaşılan bulgularından biri olduğu bilinmektedir (4). Diğer taraftan, basit ateşli nöbet geçiren çocuklarda menenjit riskinin arttığı ya da ateşli nöbetin menenjitin tek bulgusu olabileceğine ilişkin veriler çelişkilidir (5)(6)(7)(8).…”

“…2000'li yıllardan itibaren, Haemophilus influenza tip B (Hib) ve konjuge pnömokok aşılarının rutin aşı programına alındığı ülkelerde yapılan pek çok çalışmada basit ateşli nöbet dışında genel durumu iyi görünen çocuklarda ciddi sistemik bakteriyel enfeksiyon ve menenjit riskinin çok düşük olduğu ve APA önerilerinden farklı olarak, 18 aydan küçük hastalarda da LP'nin oldukça düşük oranlarda yapıldığı bildirilmektedir (7,(9)(10)(11)(12)(13).…”

Evaluation of predictive value of total leukocyte count in acute serious bacterial infections in children 1 month to 5 years

“…sometimes difficult to distinguish from those with a selflimiting viral illness and benefit from early antibiotic therapy. [3][4][5] Very often the decision to commence antibiotics is based on clinical evaluation supplemented by rapid available tests like urine routine examination and leukocyte counts. The results of microbiological cultures, the reference standard for SBI, can take up to 48 hours to arrive and cannot be used to guide management in the acute setting.…”