Which children with febrile seizures need lumbar puncture? A decision analysis approach

Am J Dis Child. 1983 Dec;137(12):1153-6. doi: 10.1001/archpedi.1983.02140380013005.


Whether all children brought to the emergency room with a first seizure and fever require lumbar puncture (LP) remains controversial. We reviewed the emergency room records of 241 children aged 6 months to 6 years who had this clinical picture. Five history and physical examination items discriminated between children with and without meningitis: a physician visit within 48 hours before the seizure; the occurrence of convulsions on arrival at the emergency room; a focal seizure; suspicious findings on physical and/or neurologic examination. Used in combination, these items (risk factors) identified all children with meningitis but would have spared 62% of children without meningitis the need for LP. In a decision analysis framework, they were as sensitive but more specific than LP in detecting children with meningitis. Most important, their negative predictive value was 100%.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Decision Making
  • Diagnosis, Differential
  • Emergency Service, Hospital
  • False Positive Reactions
  • Humans
  • Infant
  • Male
  • Medical History Taking
  • Meningitis / diagnosis*
  • Neurologic Examination
  • Physical Examination
  • Risk
  • Seizures, Febrile / diagnosis*
  • Seizures, Febrile / surgery
  • Spinal Puncture*