Frightening, yet benign, febrile seizures are seen frequently in the Emergency Department. The American Academy of Pediatrics recommends minimal evaluation for uncomplicated febrile seizures, and invasive testing only in complex cases or those with other indications for testing.
Despite this, the real-world experience documented by these authors at a community hospital in New York is slightly different. Rather than minimal testing, 100% of patients – mostly aged greater than 12 months – received a CBC and Chem7. 94% received a blood culture, 94% received a urine culture, and 85% had a chest x-ray. 24% had CSF cultures and 21% had CT scans – mostly the complex febrile seizures.
The yield of all this testing – they diagnosed a few UTIs, and one blood culture grew out salmonella. The authors appropriately feel this testing strategy is excessively wasteful – and confirms the AAP recommendations.
“Current Role of the Laboratory Investigation and Source of the Fever in the Diagnostic Approach”
http://www.ncbi.nlm.nih.gov/pubmed/22653461