Research Article| October 01 2010 To Tap or Not: Bacterial Meningitis & Complex Febrile Seizures AAP Grand Rounds (2010) 24 (4): 41. https://doi.org/10.1542/gr.24-4-41 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation To Tap or Not: Bacterial Meningitis & Complex Febrile Seizures. AAP Grand Rounds October 2010; 24 (4): 41. https://doi.org/10.1542/gr.24-4-41 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bacterial meningitis, complex febrile seizure, diagnostic spinal puncture Source: Kimia A, Ben-Joseph EP, Rudloe T, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010; 126(1): 62– 69; doi: https://doi.org/10:1542/peds.2009-2741Google Scholar To determine the rate of acute bacterial meningitis (ABM) among children presenting to the emergency department (ED) with a complex febrile seizure (CFS), investigators from the Children’s Hospital Boston conducted a retrospective cohort study. Medical records were reviewed for children ages 6 to 60 months who were evaluated in the ED after a first CFS from 1995 to 2008. A CFS was defined as a seizure with any of the following features: duration >15 minutes, focal motor activity, recurrence within 24 hours, or multiple consecutive seizures. ABM was defined as growth of a known bacterial pathogen from the cerebrospinal fluid (CSF) or CSF pleocytosis (white blood cell count >7/μL) associated with a growth of a bacterial pathogen from a blood culture. When a blood culture was positive without available CSF studies, the diagnosis of ABM was made in concordance with the treating provider. The 650,993 ED visits occurring during the study period included 526 cases of healthy children presenting with a first CFS, with a median age of 17 months. Seizures stopped spontaneously in 300 patients (57%). Most children (88%) had an unremarkable physical examination. Approximately 14% of patients had one or more previous febrile seizures. Pretreatment with antibiotics had occurred in 29% of the study group. Of the 186 patients (36%) who did not undergo lumbar puncture, 87% received follow-up at the study facility and none experienced a clinical course consistent with ABM. Among patients with CSF studies, 14 (2.7%) had CSF pleocytosis, two of whom had ABM. Both of these patients had an abnormal physical examination and a CSF culture positive for Streptococcus pneumoniae. A third child was diagnosed with ABM despite a negative CSF culture. This child had a blood culture positive for S pneumoniae; there was no available CSF cell count and the patient was treated for ABM. Only one patient with ABM presented after the introduction of the conjugated pneumococcal vaccine. The authors report a rate of ABM among children presenting to the ED with a CFS of 0.9% (95% CI, 0.2–2.7), based upon those who underwent lumbar puncture. They conclude that few patients with CFS have ABM in the absence of other signs or symptoms and note that patients whose only feature of CFS is two brief nonfocal seizures in 24 hours may have a particularly low risk of ABM. Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. There is a strong association between seizure and acute bacterial meningitis.1 However, many children who present with a seizure and ABM also have other clinical features suggestive of serious infection (eg, nuchal rigidity, altered mental status, or petechiae). The decision to... You do not currently have access to this content.