Complex Febrile Seizures, Lumbar Puncture, and Central Nervous System Infections: A National Perspective

Acad Emerg Med. 2018 Nov;25(11):1242-1250. doi: 10.1111/acem.13441. Epub 2018 May 30.


Objectives: The objective was to determine the national lumbar puncture (LP) practice patterns relative to the incidence of central nervous system (CNS) infections among children presenting to the emergency department (ED) with complex febrile seizures (CFS).

Methods: This was a retrospective study of ED visits for CFS from 2007 to 2014 in patients aged 0 to 5 years using a national sample. Primary outcomes include the frequency of LP, incidence of CNS infections, and ED disposition.

Results: Of 28,810 ED visits for CFS (44.4% female; mean age = 1.39 years), LP was performed in 7,445 (25.8%, 95% confidence interval [CI] 23.5%-28.2%). There was no significant difference in the proportion due to hospital teaching status or geographical region. The proportion decreased from 31.4% to 17.8% over the study period (Rao-Scott statistic = 5.85, p < 0.001). CNS infection was diagnosed in 80 (0.3%) encounters (95% CI = 41-112). The most commonly associated infections were otitis media (16.8%), upper respiratory infections (15.8%), and other viral infections (14.6%). A total of 14,696 encounters (51.0%, 95% CI = 47.9%-54.1%) resulted in a hospital admission.

Conclusions: Although rates have been declining, LP was performed in one-fourth of ED encounters for CFS over the 8-year study period. The incidence of CNS infections was very low, however, suggesting that this procedure could be avoided in many patients.

MeSH terms

  • Central Nervous System Infections / cerebrospinal fluid
  • Central Nervous System Infections / diagnosis
  • Central Nervous System Infections / epidemiology*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hospitalization
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Seizures, Febrile / epidemiology*
  • Spinal Puncture / statistics & numerical data*