Spinal tap and pediatric lumbar puncture research

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Avoiding unneeded spinal taps

When babies develop a fever high enough or abrupt enough to cause a seizure, frightened parents often rush them to the emergency room, where their workup frequently includes a spinal tap to rule out bacterial meningitis. Now, in the largest study to date, researchers at Boston Children's find that this procedure is probably not necessary in well-appearing children who have had a simple febrile seizure. Simple febrile seizures—a generalized seizure lasting no more than 15 minutes and not recurring within 24 hours—are common in infants and young children. "We might see at least one case per day in the emergency room," says Amir Kimia, MD, of Boston Children's Department of Emergency Medicine and the study's first author. "When it's a first event, it's pretty scary for parents - they usually call 911."

In the largest study to date, Kimia and colleagues in Boston Children's Emergency Department (ED) reviewed medical charts of 704 babies seen in Boston Children's ED between 1995 and 2006. During that time, they found no cases of bacterial meningitis. Kimia hopes these findings will reassure parents and save babies from unnecessary, invasive testing. Spinal taps requires local anesthesia and often sedation. "It's a safe procedure with an extremely low rate of complications," says Kimia. "But it's a needle and it's not fun. We're trying not to do it unless it's absolutely necessary."

Kimia hopes the findings will reassure anxious parents. "We have a hard time convincing parents in the ER that their child doesn't need a workup," he says. "Some, traumatized by the seizure, are convinced their child was about to die. But if their child is running around in our ER and is smiling and happy, lumbar puncture is probably not indicated."