Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-02T13:56:09.117Z Has data issue: false hasContentIssue false

Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows

Published online by Cambridge University Press:  11 May 2015

Justin W. Sales*
Affiliation:
Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
Blake Bulloch
Affiliation:
Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
Mark A. Hostetler
Affiliation:
Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
*
Division of Emergency Medicine, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016; [email protected].

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Febrile seizures are the most common type of childhood seizure and are categorized as simple or complex. Complex febrile seizures (CFSs) are defined as events that are focal, prolonged (> 15 minutes), or recurrent. The management of CFS is poorly defined. The objective of this study was to determine the degree of variability in the emergency department evaluation of children with CFSs.

Methods:

An online survey questionnaire was developed and sent to physicians identified via the listserv of the emergency medicine section of the American Academy of Pediatrics and the pediatric emergency medicine discussion list. The questionnaire consisted of five hypothetical case vignettes describing children under 5 years of age presenting with a CFS. Following review of the first four vignettes, participants were asked if they would (1) obtain blood and urine for evaluation; (2) perform a lumbar puncture; (3) perform neurologic imaging while the child was in the emergency department; (4) admit the child to the hospital; or (5) discharge with follow-up as an outpatient, with either the primary care provider or a neurologist. The final vignette determined if antiepileptic medication would be prescribed by the physician on discharge.

Results:

Of the 353 physicians who participated, 293 (83%) were pediatric emergency medicine attending physicians and 60 (17%) were pediatric emergency medicine fellows. Overall, 54% of participants indicated that they would obtain blood for evaluation, 62% would obtain urine, 34% would perform a lumbar puncture, and 36% would perform neurologic imaging. The overall hypothetical admission rate for the case vignettes was 42%.

Conclusions:

This study indicates that extensive variability exists in the emergency department approach to patients with CFS. Our findings suggest that optimal management for CFS remains unclear and support the potential benefit of future prospective studies on this subject.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Berg, AT, Shinnar, S. Complex febrile seizures. Epilepsia 1996;37:126–33.Google Scholar
2.American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics 1996;97:769–72.Google Scholar
3.Nelson, KB, Ellenberg, JH. Prognosis in children with febrile seizures. Pediatrics 1978;61:720–7.CrossRefGoogle ScholarPubMed
4.Verity, CM, Golding, J. Risk of epilepsy after febrile convulsions: a national cohort study. Br Med J 1991;303:1373–6.Google Scholar
5.Baram, TZ, Shinnar, S, editors. Febrile seizures. San Diego (CA): Academic Press; 2002.Google Scholar
6.Rutter, N, Smales, OR. Calcium, magnesium, glucose levels in blood and CSF of children with febrile convulsions. Arch Dis Child 1976;51:141–3.Google Scholar
7.Gerber, MA, Berliner, BC. The child with a “simple” febrile seizure: appropriate diagnostic evaluation. Am J Dis Child 1981;135:431–3.CrossRefGoogle ScholarPubMed
8.Jaffe, M, Bar-Joseph, G, Tirosh, E. Fever and convulsions—indications for laboratory investigations. Pediatrics 1981;67:729–31.CrossRefGoogle ScholarPubMed
9.Kimia, AA, Capraro, AJ, Hummel, D, et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics 2009;123:612.Google Scholar
10.Teng, D, Dayan, P, Tyler, S, et al. Risk of intracranial pathologic conditions requiring emergency intervention after a complex febrile seizure episode among children. Pediatrics 2006;117:304–8.Google Scholar
11.Al-Qudah, AA. Value of brain CT scan in children with febrile convulsions. J Neurol Sci 1995;128:107–10.CrossRefGoogle Scholar
12.Garvey, MA, Gaillard, WD, Rusin, JA, et al. Emergency brain computed tomography in children with seizures: who is most likely to benefit? J Pediatr 1998;133:664–9.Google Scholar
13.Maytal, J, Krauss, JM, Novak, G, et al. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. Epilepsia 2000;41:950–4.Google Scholar
14.Warden, CR, Zibulewsky, J, Mace, S, et al. Evaluation and management of febrile seizures in the out-of hospital and emergency department settings. Ann Emerg Med 2003;41:215–22.Google Scholar
15.Veloski, J, Tai, S, Evans, AS, et al. Clinical vignette-based surveys: a tool for assessing physician practice variation. Am J Med Qual 2005;20:151–7.CrossRefGoogle ScholarPubMed
16.Dillman, DA, Smyth, JD. Design effects in the transition to web-based surveys. Am J Prev Med 2007;32:90–6.Google Scholar
17.Dillman, DA. Mail and Internet surveys: the tailored design method. New York: Wiley; 2000.Google Scholar
18.Grandcolas, U, Rettie, R, Marusenko, K. Web survey bias: sample or mode effect? J Market Manag 2006;19:541–61.CrossRefGoogle Scholar
19.Bradley, N. Sampling for Internet surveys. An examination of respondent selection for Internet research. J Market Res Soc 1999;41:387–95.CrossRefGoogle Scholar
20.Wang, H, Doong, H. Validation in Internet survey research: reviews and future suggestions. In: Proceedings of the 40th Annual Hawaii International Conference on System Sciences. 2007. Available at: http://doi.ieeecomputersociety.org/10.1109/HICSS.2007.599 (accessed Feb 21, 2011).Google Scholar
21.Deutskens, KD, Ruyter, M, Wetzels, P, et al. Response rate and response quality of Internet-based surveys: an experimental study. Market Lett 2004;15:2136.CrossRefGoogle Scholar