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 s eizures, Methods: Multicenter, retrospective cohort study of seven EDs in t he Chicago area: two tertiary academic pediatric EDs (PEDs) and five commun ity-based general EDs (GEDs). The visits of all patients with a discharge d iagnosis including the term "seizure" were identified from a 30-month perio d. Records of patients who met criteria for simple, first-time febrile seiz ure were reviewed (age 6-60 months; temperature greater than or equal to 38 .0 degrees C; single, generalized, tonic-clonic seizure <20 minutes; "alert " or "arousable" on presentation; absence of known neurologic disease). Res ults: Four hundred fifty-five records were included: 330 and 125 patients p resenting to GEDs and PEDs, respectively. The two groups did not differ in mean age, vital signs, reported duration of seizure, or prior antibiotic us e. Lumbar puncture (LP) was performed more often in the GED group (33% vs 2 2%). No patients were found to have bacterial meningitis. The patients in t he 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 re gression 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 an tibiotics (OR 2.5), and be admitted or transferred (OR 2.5). Conclusions: T here were significant setting-based differences in the evaluation and manag ement of children with simple febrile seizures presenting to GEDs and PEDs.