Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts.
Pediatrics. 2021 Nov;148(5). doi: 10.1542/peds.2021-051517. Epub 2021 Oct 20.
We sought to measure trends in evaluation and management of children with simple febrile seizures (SFSs) before and after the American Academy of Pediatrics updated guidelines published in 2011.
In this retrospective, cross-sectional analysis, we used the Pediatric Health Information System database comprising 49 tertiary care pediatric hospitals in the United States from 2005 to 2019. We included children aged 6 to 60 months with an emergency department visit for first SFS identified using codes from the and .
We identified 142 121 children (median age 21 months, 42.4% female) with an emergency department visit for SFS. A total of 49 668 (35.0%) children presented before and 92 453 (65.1%) after the guideline. The rate of lumbar puncture for all ages declined from 11.6% (95% confidence interval [CI], 10.8% to 12.4%) in 2005 to 0.6% (95% CI, 0.5% to 0.8%) in 2019 ( < .001). Similar reductions were noted in rates of head computed tomography (10.6% to 1.6%; < .001), complete blood cell count (38.8% to 10.9%; < .001), hospital admission (19.2% to 5.2%; < .001), and mean costs ($1523 to $601; < .001). Reductions in all outcomes began before, and continued after, the publication of the American Academy of Pediatrics guideline. There was no significant change in delayed diagnosis of bacterial meningitis (preperiod 2 of 49 668 [0.0040%; 95% CI, 0.00049% to 0.015%], postperiod 3 of 92 453 [0.0032%; 95% CI, 0.00066% to 0.0094%]; = .99).
Diagnostic testing, hospital admission, and costs decreased over the study period, without a concomitant increase in delayed diagnosis of bacterial meningitis. These data suggest most children with SFSs can be safely managed without lumber puncture or other diagnostic testing.
我们旨在测量在儿科学会 2011 年更新指南发布前后，对单纯性热性惊厥（SFS）患儿的评估和管理趋势。
在这项回顾性、横断面分析中，我们使用了美国 49 家三级儿童保健医院的儿科健康信息系统数据库，时间范围为 2005 年至 2019 年。我们纳入了年龄在 6 至 60 个月之间，因首次 SFS 就诊于急诊科的患儿，使用 和 中的代码进行识别。
我们共识别出 142121 名因 SFS 就诊于急诊科的患儿（中位年龄 21 个月，42.4%为女性）。其中 49668 名（35.0%）患儿在指南发布前就诊，92453 名（65.1%）在指南发布后就诊。所有年龄段的腰椎穿刺率从 2005 年的 11.6%（95%置信区间 [CI]，10.8%至 12.4%）下降到 2019 年的 0.6%（95% CI，0.5%至 0.8%）（<0.001）。类似的降低也见于头部计算机断层扫描（10.6%至 1.6%；<0.001）、全血细胞计数（38.8%至 10.9%；<0.001）、住院治疗（19.2%至 5.2%；<0.001）和平均费用（$1523 至 $601；<0.001）。所有结局的减少均在儿科学会指南发布之前开始，并持续至指南发布之后。细菌性脑膜炎的延迟诊断并没有显著变化（前周期 49668 例中的 2 例[0.0040%；95%CI，0.00049%至 0.015%]，后周期 92453 例中的 3 例[0.0032%；95%CI，0.00066%至 0.0094%]；=0.99）。
在研究期间，诊断性检查、住院治疗和费用有所下降，而细菌性脑膜炎的延迟诊断没有增加。这些数据表明，大多数 SFS 患儿可安全地进行管理，无需进行腰椎穿刺或其他诊断性检查。
