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December 1983

Which Children With Febrile Seizures Need Lumbar Puncture?A Decision Analysis Approach

Author Affiliations

From the Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore (Drs Joffe and DeAngelis); and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia (Dr McCormick).

Am J Dis Child. 1983;137(12):1153-1156. 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%.

(Am J Dis Child 1983;137:1153-1156)

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