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The largest study conducted to date concludes that routine lumbar puncture is unnecessary for a first simple febrile seizure in well-appearing 6–to 18–month–old children, calling into question current American Academy of Pediatrics recommendations, which date from 1996.
Simple febrile seizures are generalized seizures lasting no more than 15 minutes and not recurring within 24 hours. The AAP recommends considering lumbar puncture for 12–to 18–month–olds with a first simple febrile seizure, and "strongly" considering it for 6–to 12–month–olds. But now that H. influenzae and pneumococcal vaccines have made bacterial meningitis rare, spinal taps have been on the decline.
Researchers in Children’s Division of Emergency Medicine, led by Amir Kimia, MD, staff physician in the ED, reviewed the charts of 704 babies seen for a first simple febrile seizure from 1995 to 2006. Thirty-eight percent underwent lumbar puncture that revealed an elevated white-cell count in 10 patients (3.8 percent). However, no pathogen was identified on cerebrospinal fluid cultures, and no patient was diagnosed with bacterial meningitis.
Dr. Kimia cautions that the findings, published in the January Pediatrics, don’t necessarily extend to patients with complex febrile seizures, concerning symptoms or signs of an underlying illness. "If a child appears very ill, is lethargic, fussy, non-responsive, or has neurologic symptoms or clinical signs such as a bulging fontanelle, lumbar puncture should be considered, regardless of age," he says.
Many homes harbor a threat that safety regulations, surprisingly, have overlooked: glass tables. When children jump on them, sit on them or knock them over, they can shatter, causing severe and sometimes fatal lacerations.
Glass bottles, doors and windshields–but not tables–are mandated to contain tempered glass, which is much stronger than standard glass and breaks into uniform, harmless fragments. After hearing media reports about patients with glass-table lacerations at Children’s, researchers in the Division of Emergency Medicine began a systematic study in collaboration with Consumers Union, using a computer algorithm to search electronic records.
Between 1995 and 2007, 174 injuries were logged by the Emergency Department. Chart review indicated that half would have been preventable or less severe with safety glass. Almost two-thirds of patients were male, and the median age was 3.4 years. Lacerations were most often on the face, especially in young children, followed by feet, legs, hands and arms. Forty percent of patients needed imaging to locate all the glass, and 80 percent needed surgical repair. Findings appear in the March issue of Pediatric Emergency Care.
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