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.
