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Identify and Treat the Fever

Complex febrile seizure

The majority of respondents from the Divisions of Child Neurology, Emergency Medicine, and Hospital Medicine recommended against obtaining emergent laboratory studies including cerebrospinal fluid (CSF) analysis for a child with a prolonged or focal complex febrile seizure who is back to baseline. However, a consensus was not reached, likely a consequence of the phrasing of the question. Most providers recommending laboratory investigations did so in exploration for the source of fever rather than the seizure, or for a child described with signs or symptoms of central nervous system injury or infection, who would be off-guideline.

  • Lumbar puncture (LP) is indicated in children with:

    • Signs and symptoms of central nervous system infections, who would be off guideline.

  • LP is an option in children

    • 6-12 months of age who is deficient in Hib and s pneumoniae immunization

    • whom immunization status is unknown

    • pretreated with antibiotics

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.