When less is more: Overdiagnosis and overtesting in pediatric febrile seizures in the adult emergency department.

BACKGROUND

Febrile seizures are a common pediatric condition, affecting about 1 in 25 children. Defined by a fever of 38 °C or higher without central nervous system symptoms or a history of seizures, they typically occur between 6 months and 5 years of age. Published guidelines recommend conservative management for simple febrile seizures (SFS) if the child returns to baseline. There is concern, however, about excess testing in general emergency departments. This study examined the occurrence of such unnecessary testing.

METHODS

This was a 10-year retrospective review from three emergency departments within a health care system. The study included children who met criteria for SFS and did not require hospital admission or ED transfer. Variables collected included age, temperature, tests ordered on each child: complete blood count, blood culture, nasal viral testing, urine culture, spinal fluid culture, head CT, and disposition.

RESULTS

A total of 699 children presented with either a first or subsequent febrile seizure. First time febrile seizure, the mean age was 1.89 years of age as compared to subsequent febrile seizure, mean 2.78. As a combined group, only 264 (37.8 %) of children did not undergo any testing or studies. Children who underwent a lumbar puncture, blood culture or head CT had normal/negative results. All children were discharged home.

CONCLUSION

Febrile seizures are common in pediatric emergency cases, yet a majority of children with simple febrile seizures evaluated in adult EDs still undergo unnecessary testing. This underscores a need for collaborative education and resource use in these settings.