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Romain Guedj - One of the best experts on this subject based on the ideXlab platform.
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do all children who present with a complex Febrile Seizure need a lumbar puncture
Annals of Emergency Medicine, 2017Co-Authors: Romain Guedj, Helene Chappuy, Luigi Titomanlio, Loic De Pontual, Sandra Biscardi, Gisele Nissackobiketeki, Beatrice Pellegrino, Oussama Charara, Francois AngoulvantAbstract:Study objective We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex Febrile Seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis. Methods This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex Febrile Seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents. Results From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex Febrile Seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]). Conclusion In children with a complex Febrile Seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex Febrile Seizure is not suggestive of meningitis or encephalitis.
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risk of bacterial meningitis in children 6 to 11 months of age with a first simple Febrile Seizure a retrospective cross sectional observational study
Academic Emergency Medicine, 2015Co-Authors: Romain Guedj, Helene Chappuy, Luigi Titomanlio, Sandra Biscardi, Gisele Nissackobiketeki, Beatrice Pellegrino, Oussama Charara, Thanhvan Trieu, Francois AngoulvantAbstract:Objectives National and international guidelines are very heterogeneous about the necessity to perform a lumbar puncture (LP) in children under 12 months of age with a first simple Febrile Seizure. We estimated the risk of bacterial meningitis in children aged 6 to 11 months with a first simple Febrile Seizure. Methods This multicenter retrospective study was conducted in seven pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 to 11 months for a first simple Febrile Seizure from January 2007 to December 2011 were analyzed. Bacterial meningitis was sequentially sought for by 1) analyzing bacteriologic data at the time of the visit, 2) looking for data from a second visit to the hospital after the index visit, and 3) phone calling the child's parents to determine the symptom evolution after the index visit. Infants lost to this follow-up were searched for in a national bacterial meningitis database. Results From a total of 1,183,487 visits in the seven pediatric EDs, 116,503 were for children 6 to 11 months of age. From these, 205 visits were for a first simple Febrile Seizure. An LP was performed in 61 patients (29.8%). The outcome bacterial meningitis was ascertainable for 168 (82%) visits. No bacterial meningitis was found among these patients (95% confidence interval = 0% to 2.2%). None of the 37 infants lost to our follow-up were registered in the national database as having bacterial meningitis. Conclusions Among children between 6 and 11 months of age with a first simple Febrile Seizure, the risk of bacterial meningitis is extremely low. These results should encourage national and international societies to either develop or endorse guidelines limiting routine LP in these infants and contribute to widely homogenized management practices.
Marvin B Harper - One of the best experts on this subject based on the ideXlab platform.
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should patients with complex Febrile Seizure be admitted for further management
American Journal of Emergency Medicine, 2017Co-Authors: Heather E Olson, Tiffany Rudloe, Marvin B Harper, Tobias Loddenkemper, Amir A KimiaAbstract:Abstract Background and aims Children with first complex Febrile Seizure (CFS) are often admitted for observation. The goals of this study were 1) to assess the risk of Seizure recurrence during admission, 2) to determine whether early EEG affects acute management. Design/methods We retrospectively reviewed a cohort of children 6–60 months of age admitted from a Pediatric Emergency Department for first CFS over a 15 year period. We excluded children admitted for supportive care of their Febrile illness. Data extraction included age, gender, Seizure features, laboratory and imaging studies, EEG, further Seizures during admission, and antiepileptic drugs (AEDs) given. Results One hundred eighty three children met inclusion criteria. Seven patients had Seizures during the admission (7/183 or 3.8%) Since 38 children were loaded with anti-epileptic medication during their visit, the adjusted rate is 7/145 or 4.8. Increased risk of Seizure recurrence during admission was observed in children presenting with multiple Seizures (P = 0.005). EEG was performed in 104/183 children (57%) and led to change in management in one patient (1%, 95% C.I. 0.05–6%). Six of the 7 children with Seizure had an EEG. The study was normal in 3 and findings in the other 2 did not suggest/predict further Seizures during the admission. Conclusions Children with first CFSs are at low risk for Seizure recurrence during admission. Multiple Seizures at presentation are associated with risk of early recurrence and may warrant an admission. EEG had limited effect on acute management and should not be an indication for admission.
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pediatric first time non Febrile Seizure with focal manifestations is emergent imaging indicated
Seizure-european Journal of Epilepsy, 2014Co-Authors: Nadine Aprahamian, Marvin B Harper, Sanjay P Prabhu, Michael C Monuteaux, Z Sadiq, Alcy Torres, Amir A KimiaAbstract:Abstract Purpose To assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-Febrile Seizure with focal manifestations. Methods We performed a cross sectional study of all children age 1 month to 18 years evaluated for first episode of non-Febrile Seizure with focal manifestations and having neuroimaging performed within 24h of presentation at a single pediatric ED between 1995 and 2012. We excluded intubated patients, those with known structural brain abnormality and trauma. A single neuro-radiologist reviewed all cranial computed tomography and/or magnetic resonance imaging performed. We defined clinically urgent intracranial pathology as any finding resulting in a change of initial patient management. We performed univariate analysis using χ 2 analysis for categorical data and Mann–Whitney U test for continuous data. Results We identified 319 patients having a median age of 4.6 years [IQR 1.8–9.4] of which 45% were female. Two hundred sixty-two children had a CT scan, 15 had an MR and 42 had both. Clinically urgent intra-cranial pathology was identified on imaging of 13 patients (4.1%; 95% CI: 2.2, 7.0). Infarction, hemorrhage and thrombosis were most common (9/13). Twelve of 13 were evident on CT scan. Persistent Todd's paresis and age ≤18 months were predictors of clinically urgent intracranial pathology. Absence of secondary generalization and multiple Seizures on presentation were not predictive. Conclusions Four percent of children imaged with first time, aFebrile focal Seizures have findings important to initial management. Children younger than ≤18 months are at increased risk.
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yield of emergent neuroimaging among children presenting with a first complex Febrile Seizure
Pediatric Emergency Care, 2012Co-Authors: Amir A Kimia, Andrew Capraro, David Hummel, Elana Pearl Benjoseph, Sanjay P Prabhu, Tiffany Rudloe, Dean Sarco, Marvin B HarperAbstract:ObjectivesThe objective of this study was to assess the risk of intracranial pathology requiring immediate intervention among children presenting with their first complex Febrile Seizure (CFS).Design/MethodsThis is a retrospective cohort review of patients 6 to 60 months of age evaluated in a pediat
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yield of lumbar puncture among children who present with their first complex Febrile Seizure
Pediatrics, 2010Co-Authors: Amir A Kimia, Andrew Capraro, David Hummel, Patrick Johnston, Elana Pearl Benjoseph, Tiffany Rudloe, Dean Sarco, Marvin B HarperAbstract:To assess the rate of acute bacterial meningitis (ABM) among children who present with their first complex Febrile Seizure (CFS). DESIGN AND METHODS: This study was a retrospective, cohort review of patients aged 6 to 60 months who were evaluated in a pediatric emergency department (ED) between 1995 and 2008 for their first CFS. Cases were identified by using a computerized text search followed by a manual chart review. Exclusion criteria included prior history of nonFebrile Seizures, an immunocompromised state, an underlying ill- ness associated with Seizures or altered mental status, or trauma. Data extracted included age, gender, Seizure features, the number of previous simple Febrile Seizures, temperature, a family history of sei- zures, findings on physical examination, laboratory and imaging study results, and ED diagnosis and disposition. RESULTS: We identified 526 patients. The median age was 17 months (interquartile range: 13-24), and 44% were female. Ninety patients (17%) had a previous history of simple Febrile Seizures. Of the patients, 340 (64%) had a lumbar puncture (LP). The patients' median white blood cell count during a CFS was 1 cell per L (interquartile range: 1-2), and 14 patients had CSF pleocytosis (2.7% (95% confidence inter- val (CI): 1.5- 4.5)). Three patients had ABM (0.9% (95% CI: 0.2-2.8)). Two had Streptococcus pneumoniae in a culture of their cerebrospinal fluid. Among these 2 patients, 1 was nonresponsive during presenta- tion, and the other had a bulging fontanel and apnea. The third child appeared well; however, her blood culture grew S pneumoniae and failed the LP test. None of the patients for whom an LP was not at- tempted subsequently returned to the hospital with a diagnosis of ABM (0% (95% CI: 0, 0.9)). CONCLUSION: Few patients who experienced a CFS had ABM in the absence of other signs or symptoms. Pediatrics 2010;126:62-69
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utility of lumbar puncture for first simple Febrile Seizure among children 6 to 18 months of age
Pediatrics, 2009Co-Authors: Amir A Kimia, Andrew Capraro, David Hummel, Patrick Johnston, Marvin B HarperAbstract:OBJECTIVES. American Academy of Pediatrics consensus statement recommendations are to consider strongly for infants 6 to 12 months of age with a first simple Febrile Seizure and to consider for children 12 to 18 months of age with a first simple Febrile Seizure lumbar puncture for cerebrospinal fluid analysis. Our aims were to determine compliance with these recommendations and to assess the rate of bacterial meningitis detected among these children. METHODS. A retrospective cohort review was performed for patients 6 to 18 months of age who were evaluated for first simple Febrile Seizure in a pediatric emergency department between October 1995 and October 2006. RESULTS. First simple Febrile Seizure accounted for 1% of all emergency department visits for children of this age, with 704 cases among 71 234 eligible visits during the study period. Twenty-seven percent (n = 188) of first simple Febrile Seizure visits were for infants 6 to 12 months of age, and 73% (n = 516) were for infants 12 to 18 months of age. Lumbar puncture was performed for 38% of the children (n = 271). Samples were available for 70% of children 6 to 12 months of age (131 of 188 children) and 25% of children 12 to 18 months of age (129 of 516 children). Rates of lumbar puncture decreased significantly over time in both age groups. The cerebrospinal fluid white blood cell count was elevated in 10 cases (3.8%). No pathogen was identified in cerebrospinal fluid cultures. Ten cultures (3.8%) yielded a contaminant. No patient was diagnosed as having bacterial meningitis. CONCLUSIONS. The risk of bacterial meningitis presenting as first simple Febrile Seizure at ages 6 to 18 months is very low. Current American Academy of Pediatrics recommendations should be reconsidered.
Amir A Kimia - One of the best experts on this subject based on the ideXlab platform.
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should patients with complex Febrile Seizure be admitted for further management
American Journal of Emergency Medicine, 2017Co-Authors: Heather E Olson, Tiffany Rudloe, Marvin B Harper, Tobias Loddenkemper, Amir A KimiaAbstract:Abstract Background and aims Children with first complex Febrile Seizure (CFS) are often admitted for observation. The goals of this study were 1) to assess the risk of Seizure recurrence during admission, 2) to determine whether early EEG affects acute management. Design/methods We retrospectively reviewed a cohort of children 6–60 months of age admitted from a Pediatric Emergency Department for first CFS over a 15 year period. We excluded children admitted for supportive care of their Febrile illness. Data extraction included age, gender, Seizure features, laboratory and imaging studies, EEG, further Seizures during admission, and antiepileptic drugs (AEDs) given. Results One hundred eighty three children met inclusion criteria. Seven patients had Seizures during the admission (7/183 or 3.8%) Since 38 children were loaded with anti-epileptic medication during their visit, the adjusted rate is 7/145 or 4.8. Increased risk of Seizure recurrence during admission was observed in children presenting with multiple Seizures (P = 0.005). EEG was performed in 104/183 children (57%) and led to change in management in one patient (1%, 95% C.I. 0.05–6%). Six of the 7 children with Seizure had an EEG. The study was normal in 3 and findings in the other 2 did not suggest/predict further Seizures during the admission. Conclusions Children with first CFSs are at low risk for Seizure recurrence during admission. Multiple Seizures at presentation are associated with risk of early recurrence and may warrant an admission. EEG had limited effect on acute management and should not be an indication for admission.
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utility of initial eeg in first complex Febrile Seizure
Epilepsy & Behavior, 2015Co-Authors: Chellamani Harini, Amir A Kimia, Elanagan Nagarajan, Rachel Marin De Carvalho, Ann M Bergin, Masanori Takeoka, Phillip L Pearl, Tobias LoddenkemperAbstract:Abstract Objective The risk of developing epilepsy following Febrile Seizures (FS) varies between 2% and 10%, with complex Febrile Seizures (CFS) having a higher risk. We examined the utility of detected epileptiform abnormalities on the initial EEG following a first CFS in predicting subsequent epilepsy. Methods This was a retrospective study of consecutive patients (ages 6–60 months) who were neurologically healthy or mildly delayed, seen in the ED following a first CFS and had both an EEG and minimum of 2-year follow-up. Data regarding clinical characteristics, EEG report, development of subsequent epilepsy, and type of epilepsy were collected. Established clinical predictors for subsequent epilepsy in children with FS and EEG status were evaluated for potential correlation with the development of subsequent epilepsy. Sensitivity, specificity, and positive and negative predictive values of an abnormal EEG (epileptiform EEG) were calculated. Results A group of 154 children met our inclusion criteria. Overall, 20 (13%) children developed epilepsy. The prevalence of epilepsy was 13% (CI 8.3–19.6%). Epileptiform abnormalities were noted in 21 patients (13.6%), EEG slowing in 23 patients (14.9%), and focal asymmetry in six (3.8%). Epileptiform EEGs were noted in 20% (4/20) of patients with epilepsy and 13% (17/134) of patients without epilepsy (p = 0.48). At an estimated risk of subsequent epilepsy of 10% (from population-based studies of children with FS), we determined that the PPV of an epileptiform EEG for subsequent epilepsy was 15%. None of the clinical variables (presence of more than 1 complex feature, family history of epilepsy, or status epilepticus) predicted epilepsy. Conclusions An epileptiform EEG was not a sensitive measure and had a poor positive predictive value for the development of epilepsy among neurologically healthy or mildly delayed children with a first complex Febrile Seizure. The practice of obtaining routine EEG for predicting epilepsy after the first CFS needs clarification by well-defined prospective studies.
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pediatric first time non Febrile Seizure with focal manifestations is emergent imaging indicated
Seizure-european Journal of Epilepsy, 2014Co-Authors: Nadine Aprahamian, Marvin B Harper, Sanjay P Prabhu, Michael C Monuteaux, Z Sadiq, Alcy Torres, Amir A KimiaAbstract:Abstract Purpose To assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-Febrile Seizure with focal manifestations. Methods We performed a cross sectional study of all children age 1 month to 18 years evaluated for first episode of non-Febrile Seizure with focal manifestations and having neuroimaging performed within 24h of presentation at a single pediatric ED between 1995 and 2012. We excluded intubated patients, those with known structural brain abnormality and trauma. A single neuro-radiologist reviewed all cranial computed tomography and/or magnetic resonance imaging performed. We defined clinically urgent intracranial pathology as any finding resulting in a change of initial patient management. We performed univariate analysis using χ 2 analysis for categorical data and Mann–Whitney U test for continuous data. Results We identified 319 patients having a median age of 4.6 years [IQR 1.8–9.4] of which 45% were female. Two hundred sixty-two children had a CT scan, 15 had an MR and 42 had both. Clinically urgent intra-cranial pathology was identified on imaging of 13 patients (4.1%; 95% CI: 2.2, 7.0). Infarction, hemorrhage and thrombosis were most common (9/13). Twelve of 13 were evident on CT scan. Persistent Todd's paresis and age ≤18 months were predictors of clinically urgent intracranial pathology. Absence of secondary generalization and multiple Seizures on presentation were not predictive. Conclusions Four percent of children imaged with first time, aFebrile focal Seizures have findings important to initial management. Children younger than ≤18 months are at increased risk.
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yield of emergent neuroimaging among children presenting with a first complex Febrile Seizure
Pediatric Emergency Care, 2012Co-Authors: Amir A Kimia, Andrew Capraro, David Hummel, Elana Pearl Benjoseph, Sanjay P Prabhu, Tiffany Rudloe, Dean Sarco, Marvin B HarperAbstract:ObjectivesThe objective of this study was to assess the risk of intracranial pathology requiring immediate intervention among children presenting with their first complex Febrile Seizure (CFS).Design/MethodsThis is a retrospective cohort review of patients 6 to 60 months of age evaluated in a pediat
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yield of lumbar puncture among children who present with their first complex Febrile Seizure
Pediatrics, 2010Co-Authors: Amir A Kimia, Andrew Capraro, David Hummel, Patrick Johnston, Elana Pearl Benjoseph, Tiffany Rudloe, Dean Sarco, Marvin B HarperAbstract:To assess the rate of acute bacterial meningitis (ABM) among children who present with their first complex Febrile Seizure (CFS). DESIGN AND METHODS: This study was a retrospective, cohort review of patients aged 6 to 60 months who were evaluated in a pediatric emergency department (ED) between 1995 and 2008 for their first CFS. Cases were identified by using a computerized text search followed by a manual chart review. Exclusion criteria included prior history of nonFebrile Seizures, an immunocompromised state, an underlying ill- ness associated with Seizures or altered mental status, or trauma. Data extracted included age, gender, Seizure features, the number of previous simple Febrile Seizures, temperature, a family history of sei- zures, findings on physical examination, laboratory and imaging study results, and ED diagnosis and disposition. RESULTS: We identified 526 patients. The median age was 17 months (interquartile range: 13-24), and 44% were female. Ninety patients (17%) had a previous history of simple Febrile Seizures. Of the patients, 340 (64%) had a lumbar puncture (LP). The patients' median white blood cell count during a CFS was 1 cell per L (interquartile range: 1-2), and 14 patients had CSF pleocytosis (2.7% (95% confidence inter- val (CI): 1.5- 4.5)). Three patients had ABM (0.9% (95% CI: 0.2-2.8)). Two had Streptococcus pneumoniae in a culture of their cerebrospinal fluid. Among these 2 patients, 1 was nonresponsive during presenta- tion, and the other had a bulging fontanel and apnea. The third child appeared well; however, her blood culture grew S pneumoniae and failed the LP test. None of the patients for whom an LP was not at- tempted subsequently returned to the hospital with a diagnosis of ABM (0% (95% CI: 0, 0.9)). CONCLUSION: Few patients who experienced a CFS had ABM in the absence of other signs or symptoms. Pediatrics 2010;126:62-69
William D Fraser - One of the best experts on this subject based on the ideXlab platform.
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age at first Febrile Seizure correlates with perinatal maternal emotional symptoms
Epilepsy Research, 2017Co-Authors: Fanny Thebaultdagher, Catherine M Herba, Jean R Seguin, Gina Muckle, Sonia J Lupien, Lionel Carmant, Marienoelle Simard, Gabriel D Shapiro, William D FraserAbstract:Abstract Objective Prenatal exposure to stress and fever are factors lowering Seizure threshold in animal models. The fever effect on Seizure threshold is well documented in human infants, however the associations between maternal perinatal stress and infants’ susceptibility to Seizures is unknown. This is the first study in humans to investigate longitudinally, whether in humans, the effect of maternal perinatal emotional symptoms such as stress, anxiety and depression that may trigger a biological stress response on age at first Seizure occurrence. Method The study sample is a subgroup drawn from a longitudinal follow up cohort (3D cohort study: Design, Develop, Discover, N = 2366 mother-infant dyads). Twenty-nine otherwise healthy infants who had a Febrile Seizure (FS) episode before the last follow-up visit (around 24 months of age) were studied. Mothers completed questionnaires regarding their emotional health at each pregnancy trimester and at three months postpartum. The link between maternal emotional symptoms and infant age at first FS was assessed through correlations and multiple regressions. Results We found that maternal anxiety symptoms during the second trimester of pregnancy are linked to the age at first FS (r(23) = −0.459, p = 0.021) and explain 21.1% of its variance. Postnatal maternal depression symptoms at 3 months postpartum were also associated with the age at first FS (r(23) = −0.587, p = 0.002) and explained an additional 17.6% of variance. Together, the variables explained 38.7% of the variance in age at first FS. Maternal perceived stress symptoms at 3 months postpartum were also linked to the age at first FS (r(23) = −0.418, p = 0.038), however, stress did not significantly contribute to the variance of age at first FS.. Significance Our results suggest a link between increased perinatal maternal emotional symptoms and the age at first FS. An earlier age at first FS may be the manifestation of a lower Seizure threshold. Early first Seizure occurrence is a risk factor for compromised neurological and cognitive development. Further studies should address the mechanisms by which perinatal maternal emotional symptoms may have an impact on Seizure threshold in humans.
Francois Angoulvant - One of the best experts on this subject based on the ideXlab platform.
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do all children who present with a complex Febrile Seizure need a lumbar puncture
Annals of Emergency Medicine, 2017Co-Authors: Romain Guedj, Helene Chappuy, Luigi Titomanlio, Loic De Pontual, Sandra Biscardi, Gisele Nissackobiketeki, Beatrice Pellegrino, Oussama Charara, Francois AngoulvantAbstract:Study objective We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex Febrile Seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis. Methods This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex Febrile Seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents. Results From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex Febrile Seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]). Conclusion In children with a complex Febrile Seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex Febrile Seizure is not suggestive of meningitis or encephalitis.
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risk of bacterial meningitis in children 6 to 11 months of age with a first simple Febrile Seizure a retrospective cross sectional observational study
Academic Emergency Medicine, 2015Co-Authors: Romain Guedj, Helene Chappuy, Luigi Titomanlio, Sandra Biscardi, Gisele Nissackobiketeki, Beatrice Pellegrino, Oussama Charara, Thanhvan Trieu, Francois AngoulvantAbstract:Objectives National and international guidelines are very heterogeneous about the necessity to perform a lumbar puncture (LP) in children under 12 months of age with a first simple Febrile Seizure. We estimated the risk of bacterial meningitis in children aged 6 to 11 months with a first simple Febrile Seizure. Methods This multicenter retrospective study was conducted in seven pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 to 11 months for a first simple Febrile Seizure from January 2007 to December 2011 were analyzed. Bacterial meningitis was sequentially sought for by 1) analyzing bacteriologic data at the time of the visit, 2) looking for data from a second visit to the hospital after the index visit, and 3) phone calling the child's parents to determine the symptom evolution after the index visit. Infants lost to this follow-up were searched for in a national bacterial meningitis database. Results From a total of 1,183,487 visits in the seven pediatric EDs, 116,503 were for children 6 to 11 months of age. From these, 205 visits were for a first simple Febrile Seizure. An LP was performed in 61 patients (29.8%). The outcome bacterial meningitis was ascertainable for 168 (82%) visits. No bacterial meningitis was found among these patients (95% confidence interval = 0% to 2.2%). None of the 37 infants lost to our follow-up were registered in the national database as having bacterial meningitis. Conclusions Among children between 6 and 11 months of age with a first simple Febrile Seizure, the risk of bacterial meningitis is extremely low. These results should encourage national and international societies to either develop or endorse guidelines limiting routine LP in these infants and contribute to widely homogenized management practices.
