All of the authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the Board of Directors. The AAP reported having neither solicited nor accepted any commercial involvement in the development of the revised guideline.
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Lumbar Puncture Advice Helpful
The guidelines on when to do a lumbar puncture “in the context of lack of immunization and pretreatment with antibiotics will be most useful with regard to decision making in this carefully defined patient population,” Dr. Jeffrey Buchhalter said in an interview. The authors “were very specific regarding age of inclusion and consideration of only simple febrile seizures in their recommendation.”
“My general impression is that many individuals who evaluate children with simple febrile seizures recognize the very low utility of neuroimaging but obtain head CT anyway due to concern regarding litigation if anything is missed. The strong recommendation not to obtain skull films is appropriate, but in my experience has not been used with any frequency during the last decade,” he said.
“The guidelines make sense as so much credence is given to observational studies – what we commonly see in clinical practice. Furthermore, the recommendations take into account a benefit/harm consideration that each clinician confronts. Thus, implementation should occur with a caveat regarding perceived medical-legal liability regarding neuroimaging and other testing.
“However, a potential reason not to implement these guidelines is precisely because of the lack of high-quality evidence proving or disproving each recommendation. This is an interesting conundrum that we face in creating guidelines that are truly evidence based yet clinically relevant,” Dr. Buchhalter concluded.
DR. BUCHHALTER is chief of neurology at Phoenix Children's Hospital. Dr. Buchhalter has received personal compensation for activities with the National Institute of Neurological Disorders and Stroke, and he has received research support from Ovation Pharmaceuticals, Inc. and Pfizer Inc.
