Setting-based practice variation in the management of simple febrile seizure

Objective: To identify provider-based differences in the ED assessment and management of children presenting with uncomplicated, first-time febrile seizures. Methods: Multicenter, retrospective cohort study of seven EDs in the Chicago area: two tertiary academic pediatric EDs (PEDs) and five community-based general EDs (GEDs). The visits of all patients with a discharge diagnosis including the term 'seizure' were identified from a 30- month period. Records of patients who met criteria for simple, first-time febrile seizure were reviewed (age 6-60 months; temperature ≥38.0°C; single, generalized, tonic-clonic seizure <20 minutes; 'alert' or 'arousable' on presentation; absence of known neurologic disease). Results: Four hundred fifty-five records were included: 330 and 125 patients presenting to GEDs and PEDs, respectively. The two groups did not differ in mean age, vital signs, reported duration of seizure, or prior antibiotic use. Lumbar puncture (LP) was performed more often in the GED group (33% vs 22%). No patients were found to have bacterial meningitis. The patients in the GED group were more likely to receive parenteral antibiotics in the ED (56% vs 22%) and to be admitted or transferred (18% vs 4%). In a logistic regression model incorporating age, temperature, seizure duration, seizure in the ED, prior antibiotic use, primary care, and insurance status, the GED patients remained more likely to have an LP (OR 1.5), receive parenteral antibiotics (OR 2.5), and be admitted or transferred (OR 2.5). Conclusions: There were significant setting-based differences in the evaluation and management of children with simple febrile seizures presenting to GEDs and PEDs.