Department of Pediatrics, North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Children's Hospital Association, Overland Park, Kansas, USA.
J Hosp Med. 2022 May;17(5):327-341. doi: 10.1002/jhm.12833. Epub 2022 May 13.
Current guidelines recommend against neurodiagnostic testing for the evaluation of simple febrile seizures.
(1) Assess overall and institutional rates of neurodiagnostic testing and (2) establish achievable benchmarks of care (ABCs) for children evaluated for simple febrile seizures at children's hospitals.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of children 6 months to 5 years evaluated in the emergency department (ED) 2016-2019 with simple febrile seizures at 38 children's hospitals in Pediatric Health Information System database. We excluded children with epilepsy, complex febrile seizures, complex chronic conditions, and intensive care.
Proportions of children who received neuroimaging, electroencephalogram (EEG), or lumbar puncture (LP) and rates of hospitalization for study cohort and individual hospitals. Hospital-specific outcomes were adjusted for patient demographics and severity of illness. We utilized hospital-specific values for each measure to calculate ABCs.
We identified 51,015 encounters. Among the study cohort 821 (1.6%) children had neuroimaging, 554 (1.1%) EEG, 314 (0.6%) LP, and 2023 (4.0%) were hospitalized. Neurodiagnostic testing rates varied across hospitals: neuroimaging 0.4%-6.7%, EEG 0%-8.2%, LP 0%-12.7% in patients <1-year old and 0%-3.1% in patients ≥1 year. Hospitalization rate ranged from 0%-14.5%. Measured outcomes were higher among hospitalized versus ED-only patients: neuroimaging 15.3% versus 1.0%, EEG% 24.7 versus 0.1% (p < .001). Calculated ABCs were 0.6% for neuroimaging, 0.1% EEG, 0% LP, and 1.0% hospitalization.
Rates of neurodiagnostic testing and hospitalization for simple febrile seizures were low but varied across hospitals. Calculated ABCs were 0%-1% for all measures, demonstrating that adherence to current guidelines is attainable.
目前的指南不建议对单纯性热性惊厥进行神经诊断测试。
（1）评估神经诊断测试的总体和机构比率，（2）为在儿童医院评估单纯性热性惊厥的儿童制定可实现的护理基准（ABC）。
设计、地点和参与者：对 2016 年至 2019 年在儿科健康信息系统数据库中 38 家儿童医院急诊科就诊的 6 个月至 5 岁患有单纯性热性惊厥的儿童进行的横断面研究。我们排除了患有癫痫、复杂性热性惊厥、复杂慢性疾病和重症监护的儿童。
研究队列和个别医院接受神经影像学、脑电图（EEG）或腰椎穿刺（LP）的儿童比例以及住院率。根据患者人口统计学和疾病严重程度调整了医院特定的结果。我们利用每个措施的医院特定值来计算 ABC。
我们确定了 51015 次就诊。在研究队列中，821 名（1.6%）儿童接受了神经影像学检查，554 名（1.1%）接受了 EEG 检查，314 名（0.6%）接受了 LP 检查，2023 名（4.0%）住院。神经诊断测试率在各医院之间存在差异：神经影像学 0.4%-6.7%，脑电图 0%-8.2%，腰椎穿刺 0%-12.7%在 <1 岁的患者中，0%-3.1%在≥1 岁的患者中。住院率从 0%-14.5%不等。与仅在急诊科就诊的患者相比，住院患者的神经诊断测试率和住院率更高：神经影像学 15.3%比 1.0%，脑电图%24.7%比 0.1%（p < .001）。计算得出的 ABC 分别为神经影像学 0.6%、脑电图 0.1%、腰椎穿刺 0%和住院率 1.0%。
单纯性热性惊厥的神经诊断测试和住院率较低，但在各医院之间存在差异。所有措施的计算 ABC 均为 0%-1%，表明可实现对当前指南的依从性。
