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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 15 month old brought in for simple febrile seizure lasting 2 minutes. The child is back to baseline and well appearing. The vital signs are temperature 40.4 C, HR 175, RR 30, BP 80/40. Exam reveals no source for infection. The child has no vaccinations at all by parent choice.
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July 21, 2019 at 12:03 am
Najef-Zadeh et al (2013: PLoS ONE 8(1): e55270) performed a meta-analysis of studies of prevalence of bacterial meningitis in children presenting with fever + seizure. The overall prevalence was 2.6% (95% CI 0.9-5.1%) but 95% of the bacterial meningitis patients could be suspected to have meningitis from clinical exam. Of patients that met the definition of simple febrile seizure 0.2% (95% CI 0-1%) had bacterial meningitis, and the number needed to tap would be 1,109. For complex febrile seizure, the rate was 0.6% (0.2-1.5%) with a number needed to tap of 180. The authors noted that 223 of the simple febrile seizure patients were from the pre-vaccine era, and still only 1 had bacterial meningitis.