Guedj Romain, Chappuy Hélène, Titomanlio Luigi, Trieu Thanh-Van, Biscardi Sandra, Nissack-Obiketeki Gisèle, Pellegrino Béatrice, Charara Oussama, Angoulvant François, Villemeur Thierry Billette De, Levy Corinne, Cohen Robert, Armengaud Jean Baptiste, Carbajal Ricardo
Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France.
INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemilogy Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
Acad Emerg Med. 2015 Nov;22(11):1290-7. doi: 10.1111/acem.12798. Epub 2015 Oct 15.
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.
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.
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.
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.
对于12个月以下首次单纯性热性惊厥患儿是否有必要进行腰椎穿刺（LP），国内和国际指南的意见非常不一致。我们评估了6至11个月首次单纯性热性惊厥患儿发生细菌性脑膜炎的风险。
这项多中心回顾性研究在法国巴黎地区的7个儿科急诊科进行。分析了2007年1月至2011年12月期间6至11个月首次单纯性热性惊厥患儿的就诊情况。通过以下方式依次查找细菌性脑膜炎：1）分析就诊时的细菌学数据；2）查找首次就诊后第二次到医院就诊的数据；3）给患儿家长打电话以确定首次就诊后症状的演变。在全国细菌性脑膜炎数据库中查找失访婴儿。
在7个儿科急诊科的总共1,183,487次就诊中，116,503次是6至11个月大的儿童。其中，205次就诊是首次单纯性热性惊厥。61例患者（29.8%）进行了腰椎穿刺。168次（82%）就诊的细菌性脑膜炎结局是可确定的。这些患者中未发现细菌性脑膜炎（95%置信区间=0%至2.2%）。在我们的随访中失访的37名婴儿中，没有一个在全国数据库中登记为患有细菌性脑膜炎。
在6至11个月首次单纯性热性惊厥的儿童中，细菌性脑膜炎的风险极低。这些结果应促使国内和国际学会制定或认可限制对这些婴儿进行常规腰椎穿刺的指南，并有助于广泛统一管理实践。
