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28-2-16
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://aapgrandrounds.aappublications.org/content/28/2/16
AAP Grand Rounds is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1999. AAP Grand Rounds is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2012 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1099-6605.
EMERGENCY MEDICINE
Commentary by
Michelle Stevenson, MD, MS, FAAP, Pediatric Emergency Medicine, University of Louisville, Louisville, KY
Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The authors of this study address an important clinical question for which there is a paucity of evidence. Although the guidelines published by the American Academy of Pediatrics concerning the management of a first simple febrile seizure recommend against routine neuroimaging,1 there are no recommendations to guide management of CFSs. This study has a number of limitations. Most notably, only half of the identified children with CFS included in the study underwent neuroimaging. None of the children in whom neuroimaging was not performed returned to Childrens Hospital Boston with a diagnosis of intracranial hemorrhage or mass, but these children could have subsequently been treated at other hospitals. If the risk of clinically significant intracranial pathology is calculated only among the subset of CFS patients who received emergent neuroimaging, it rises to 1.5% with an upper boundary of the 95% CI of 4%, which may be above the threshold to test for some providers. Regardless, this study should make clinicians think twice about ordering emergent neuroimaging for children with new-onset CFS when there are no other concerning signs and symptoms on physical examination, especially for children who experience a second febrile seizure within 24 hours that is neither prolonged nor focal.
References
1. American Academy of Pediatrics. Subcommittee on Febrile Seizures. Pediatrics. 2011;127(2):389-394; doi:10.1542/peds.2010-3318
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Is Neuroimaging Necessary After a First Complex Febrile Seizure? AAP Grand Rounds 2012;28;16 DOI: 10.1542/gr.28-2-16
including high resolution figures, can be found at: http://aapgrandrounds.aappublications.org/content/28/2/16 This article cites 2 articles, 1 of which you can access for free at: http://aapgrandrounds.aappublications.org/content/28/2/16#BIBL This article, along with others on similar topics, appears in the following collection(s): Emergency Medicine http://aapgrandrounds.aappublications.org/cgi/collection/emergency_m edicine_sub Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtml Information about ordering reprints can be found online: /site/misc/reprints.xhtml
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