LP for Complex Febrile Seizures

Dr. Molly McCormack



Guedj, Romain et al. Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?. Annals of Emergency Medicine. 2017; 70 (1) 52-62.e6. 

Study Design

Multicenter, retrospective study collecting data from 7 pediatric EDs in Paris, France from 2007 to 2011.

Charts were reviewed looking for specific wording to identify children who met diagnostic criteria for complex febrile seizure. Subgroups were established for patients whose clinical exam was suggestive of meningitis or encephalitis vs those whose exam was not.

Of all the patients with complex febrile seizures, 260 had an LP performed on initial visit.  If they did not have an LP performed follow up was attempted. Charts were reviewed for the second hospital visit,  parents were called to determine the child’s outcome, and a national meningitis database was reviewed for all children in the study.


Of the 839 patients who presented for complex febrile seizures, 260 (31%) had lumbar punctures done in the ED. The outcomes of bacterial meningitis and HSV-ME were seen with 5 cases (0.7%) of bacterial meningitis in this study. All with meningitis had an LP performed on the initial visit. No subsequent negative outcomes were identified for those patients who did not receive an LP and were sent home. Among the 630 visits of children with a clinical exam that was not suggestive of meningitis or encephalitis, there were no cases of bacterial meningitis and no HSV. The outcomes of 15% of patients were left unconfirmed, as their parents could not be reached. However, these children were not found in the national database and therefore imply a low likelihood that meningitis was missed. 

In children with complex febrile seizures, routine LP is not needed as bacterial meningitis and HSV-ME are unexpected and unlikely events when the clinical examination is not concerning. 


Will this study change my clinical practice?  Possibly.

This study helped me see the following: