Shaked Oranit, Peña Barbara M Garcia, Linares Marc Y R, Baker Rodney L
Division of Emergency Medicine, Department of Pediatrics, Miami Children's Hospital, Miami, FL 33155, USA.
Pediatr Emerg Care. 2009 Jan;25(1):8-11. doi: 10.1097/PEC.0b013e318191da93.
In 1996, the American Academy of Pediatrics (AAP) published a practice parameter recommending that lumbar puncture (LP) be strongly considered in infants younger than 12 months presenting with a first febrile seizure.
We sought: (1) to determine if the recommendations of the AAP are being followed by pediatric emergency medicine-trained physicians at our institution; (2) to describe the rate of meningitis among patients with febrile seizure who underwent LP; and (3) to determine if there were differences in performance of LP if children were younger or pretreated with antibiotics.
A retrospective chart review of patients aged 6 to 12 months presenting with first simple febrile seizure to the emergency department (ED) at Miami Children's Hospital was conducted between January 2001 and November 2005.
A total of 242 ED records with a discharge diagnosis including the term "febrile seizure," "seizure," or "meningitis" were identified. Of those, 56 met inclusion criteria for first simple febrile seizure. Lumbar puncture was performed in 28 patients (50%) that met inclusion criteria. Younger patients were no more likely to have LP performed than older patients (P = 0.15). Ten children (17.8%) received antibiotics before the ED visit; of these, 4 (40%) underwent LP in the ED. Children who presented with first simple febrile seizure to our institution who were pretreated with antibiotics were no more likely to have LP performed than those who were not receiving antibiotics (P = 0.48). All cerebrospinal fluid cultures were sterile.
The AAP recommendations regarding LP in patients 6 to 12 months of age with first simple febrile seizure are not being strictly adhered to. The AAP recommendations regarding simple febrile seizures were conceived in a different epidemiologic era of disease pathology with data not representative of current prevalence and etiologic issues and need to be revisited.
1996年，美国儿科学会（AAP）发布了一项实践参数，建议对于首次热性惊厥的12个月以下婴儿应强烈考虑进行腰椎穿刺（LP）。
我们试图：（1）确定我们机构中接受儿科急诊医学培训的医生是否遵循AAP的建议；（2）描述接受LP的热性惊厥患者中的脑膜炎发生率；（3）确定如果儿童年龄较小或预先使用了抗生素，LP的实施情况是否存在差异。
对2001年1月至2005年11月期间在迈阿密儿童医院急诊科就诊的6至12个月大首次单纯热性惊厥患者进行回顾性病历审查。
共识别出242份出院诊断中包含“热性惊厥”“惊厥”或“脑膜炎”的急诊记录。其中，56例符合首次单纯热性惊厥的纳入标准。28例（50%）符合纳入标准的患者进行了腰椎穿刺。年龄较小的患者进行LP的可能性并不比年龄较大的患者更高（P = 0.15）。10名儿童（17.8%）在急诊就诊前接受了抗生素治疗；其中4例（40%）在急诊科进行了LP。在我们机构首次出现单纯热性惊厥且预先接受抗生素治疗的儿童进行LP的可能性并不比未接受抗生素治疗的儿童更高（P = 0.48）。所有脑脊液培养均无菌。
AAP关于6至12个月大首次单纯热性惊厥患者进行LP的建议未得到严格遵守。AAP关于单纯热性惊厥的建议是在疾病病理学的不同流行病学时代提出的，其数据不能代表当前的患病率和病因问题，需要重新审视。
