No Sense Making Sense of <i>State v Messenger</i>

Nozicka, Charles A.; Duffner, Patricia K.

doi:10.1542/peds.99.2.306a

Cited by 7 publications

(3 citation statements)

References 3 publications

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“…These recommendations were based on the knowledge that seizure is a common presenting symptom of bacterial meningitis, 3,4 clinical skills and experience vary widely among examiners, and clinical assessment of children at this age for subtle signs can be difficult. However, the issue of whether a well-appearing child presenting with an FSFS is at increased risk for bacterial meningitis has remained controversial, [5][6][7] because of a lack of quantitative data and the inclusion of data from the pre-Haemophilus influenza type B vaccine era. 8 Although seizure is a common symptom among patients presenting with bacterial meningitis, it is quite uncommon for a simple, brief, nonfocal seizure to be the sole manifestation of bacterial meningitis.…”

mentioning

confidence: 99%

Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age

et al. 2009

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mentioning

confidence: 99%

Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age

et al. 2009

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“…15 The AAP practice parameter has been criticized as being too conservative and not representative of recent literature. 16 The AAP recommendations were based on 1977 studies in which ϳ30% to 35% of the children with febrile seizures who presented without additional meningeal signs nevertheless had bacterial meningitis (these children were primarily Ͻ18 months of age). 15,17,18 The AAP maintained that the recommendation is conservative because it is intended for practitioners with a wide range of experience.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Meningitis Presenting With a Simple Febrile Seizure and Negative Blood-Culture Result

Golnik

2007

Pediatrics

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A 12-month-old girl with occult bacterial meningitis presented with a simple febrile seizure. On examination, the patient was alert, interactive, and smiling responsively without meningeal signs, focal neurologic findings, or signs of extreme illness. Her parents were reluctant to allow a lumbar puncture, and the patient was admitted for observation without lumbar puncture. Her fever resolved, and she was playful, had good oral intake, and was discharged 24 hours after admission. Her initial blood-culture result remained negative. Within 24 hours of discharge, the patient had a focal febrile seizure, came back to the hospital, and was found to have meningitis with a penicillin-susceptible, nonvaccine Streptococcus pneumoniae strain 12F.

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“…As the clinical evaluation skills vary between examiners, a deliberately conservative approach was chosen by the AAP, aiming solely to give guidance but not to eliminate clinical judgment. Although an LP is to be "strongly considered" in certain situations, the practice parameter does not suggest that it should be mandatory [7]. Using a systematic grading of the level of evidence used to develop these guidelines (Table 1) would result in a level of evidence of 4 at the best, making it virtually of no use to derive robust conclusions and recommendations.…”

Section: Introductionmentioning

confidence: 99%

Febrile convulsions: When is a lumbar puncture indicated?

Narchi

2015

J Pediatr Neurol

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Febrile convulsions are common. Although they have an excellent long-term prognosis regarding the risk of epilepsy later in life, the main challenge posed upon presentation is whether a lumbar puncture is indicated in very young children. Despite several authoritative guidelines over the past 15 years, there is still no consensus, with seemingly contradictory recommendations. In addition, the practice varies considerably among health care workers with a trend toward fewer lumbar punctures being performed. The epidemiology of bacterial meningitis has also changed considerably over the past two decades, both in its overall prevalence and also in the bacterial etiology. We believe that all these reasons provide the opportunity to critically review the available evidence for the likelihood of bacterial meningitis presenting as an isolated febrile convulsion. We also wish to estimate its true prevalence, grading the level of that evidence for this practice and also identify subgroups where meningitis is more likely. Finally, since most guidelines are based on the assumption that normal cerebral spinal fluid results would confidently exclude bacterial meningitis, we address the validity of this assumption. Following the critical review, modified guidelines are suggested, with support of grading of the level of evidence behind them and of the strength of those recommendations.

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No Sense Making Sense of State v Messenger

Cited by 7 publications

References 3 publications

Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age

Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age

Pneumococcal Meningitis Presenting With a Simple Febrile Seizure and Negative Blood-Culture Result

Febrile convulsions: When is a lumbar puncture indicated?

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