Courtesy of Dr. Elikashvili.
20 month old female is BIBEMS after seizure at home just prior to presentation. Mother describes “10 minutes” of what sounds like generalized tonic-clonic movements. No h/o seizures. Child was born full term and 18 month vaccines UTD. She reports 2 days preceding fever, no URI, cough, diarrhea, rash, but decreased wet diapers today. Not on any antibiotics. Rectal temp is 104.0, HR 125. Currently the child is cranky but interacting with mother. You are able flex her neck and hips easily, no rash noted.
Should the patient get an LP?
No. Practice guidelines published by the AAP last year outline the diagnostic approach to simple febrile seizures (defined as non-focal, lasting <15 min, w/o recurrence in 24 hrs).
1) Children whose history or physical suggest meningitis should get an LP.
2) Infants between 6-12 months who have incomplete or unknown immunizations should be considered for LP (given their susceptibility to Hib and strep pneumo). This is a judgement call.
3) Children who were already on antibiotics for other reasons should be considered for LP since abx can mask symptoms of meningitis. Another judgement call based on type and length of time on antibiotics.
4) EEG is unhelpful in management and has no predictive value for future episodes.
5) Basic labs (BMP, CBC) are not helpful.
6) CT and MRI are not necessary.
Approach this child as you would any 20-month old with fever.