Simple Febrile Seizures: Are the AAP Guidelines Regarding Lumbar Puncture Being Followed?

Pediatr Emerg Care. 2009 Jan;25(1):8-11. doi: 10.1097/PEC.0b013e318191da93.


Background: In 1996, the American Academy of Pediatrics (AAP) published a practice parameter recommending that lumbar puncture (LP) be strongly considered in infants younger than 12 months presenting with a first febrile seizure.

Objective: We sought: (1) to determine if the recommendations of the AAP are being followed by pediatric emergency medicine-trained physicians at our institution; (2) to describe the rate of meningitis among patients with febrile seizure who underwent LP; and (3) to determine if there were differences in performance of LP if children were younger or pretreated with antibiotics.

Methods: A retrospective chart review of patients aged 6 to 12 months presenting with first simple febrile seizure to the emergency department (ED) at Miami Children's Hospital was conducted between January 2001 and November 2005.

Results: A total of 242 ED records with a discharge diagnosis including the term "febrile seizure," "seizure," or "meningitis" were identified. Of those, 56 met inclusion criteria for first simple febrile seizure. Lumbar puncture was performed in 28 patients (50%) that met inclusion criteria. Younger patients were no more likely to have LP performed than older patients (P = 0.15). Ten children (17.8%) received antibiotics before the ED visit; of these, 4 (40%) underwent LP in the ED. Children who presented with first simple febrile seizure to our institution who were pretreated with antibiotics were no more likely to have LP performed than those who were not receiving antibiotics (P = 0.48). All cerebrospinal fluid cultures were sterile.

Conclusion: The AAP recommendations regarding LP in patients 6 to 12 months of age with first simple febrile seizure are not being strictly adhered to. The AAP recommendations regarding simple febrile seizures were conceived in a different epidemiologic era of disease pathology with data not representative of current prevalence and etiologic issues and need to be revisited.

MeSH terms

  • Cerebrospinal Fluid / cytology
  • Cerebrospinal Fluid / microbiology
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Florida / epidemiology
  • Guideline Adherence / statistics & numerical data*
  • Heptavalent Pneumococcal Conjugate Vaccine
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Incidence
  • Infant
  • Male
  • Meningitis, Pneumococcal / cerebrospinal fluid*
  • Meningitis, Pneumococcal / complications
  • Meningitis, Pneumococcal / diagnosis
  • Meningitis, Pneumococcal / epidemiology
  • Meningitis, Pneumococcal / prevention & control
  • Pneumococcal Vaccines
  • Practice Guidelines as Topic*
  • Retrospective Studies
  • Seizures, Febrile / cerebrospinal fluid*
  • Seizures, Febrile / etiology
  • Spinal Puncture / statistics & numerical data*
  • Unnecessary Procedures*
  • Vaccination


  • Heptavalent Pneumococcal Conjugate Vaccine
  • Pneumococcal Vaccines