We sought to measure trends in evaluation and management of children with simple febrile seizures (SFSs) before and after the American Academy of Pediatrics updated guidelines published in 2011.

In this retrospective, cross-sectional analysis, we used the Pediatric Health Information System database comprising 49 tertiary care pediatric hospitals in the United States from 2005 to 2019. We included children aged 6 to 60 months with an emergency department visit for first SFS identified using codes from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases 10th Revision.

We identified 142 121 children (median age 21 months, 42.4% female) with an emergency department visit for SFS. A total of 49 668 (35.0%) children presented before and 92 453 (65.1%) after the guideline. The rate of lumbar puncture for all ages declined from 11.6% (95% confidence interval [CI], 10.8% to 12.4%) in 2005 to 0.6% (95% CI, 0.5% to 0.8%) in 2019 (P < .001). Similar reductions were noted in rates of head computed tomography (10.6% to 1.6%; P < .001), complete blood cell count (38.8% to 10.9%; P < .001), hospital admission (19.2% to 5.2%; P < .001), and mean costs ($1523 to $601; P < .001). Reductions in all outcomes began before, and continued after, the publication of the American Academy of Pediatrics guideline. There was no significant change in delayed diagnosis of bacterial meningitis (preperiod 2 of 49 668 [0.0040%; 95% CI, 0.00049% to 0.015%], postperiod 3 of 92 453 [0.0032%; 95% CI, 0.00066% to 0.0094%]; P = .99).

Diagnostic testing, hospital admission, and costs decreased over the study period, without a concomitant increase in delayed diagnosis of bacterial meningitis. These data suggest most children with SFSs can be safely managed without lumber puncture or other diagnostic testing.

我们试图衡量在美国儿科学会 2011 年发布更新指南之前和之后对单纯性热性惊厥 (SFS) 儿童进行评估和管理的趋势。

在这项回顾性、横断面分析中，我们使用了儿科健康信息系统数据库，该数据库包含 2005 年至 2019 年间美国 49 家三级保健儿科医院。我们纳入了 6 至 60 个月的儿童，他们因首次 SFS 就诊于急诊科来自国际疾病分类第 9 版和国际疾病分类第 10 版的代码。

我们确定了 142 121 名儿童（中位年龄 21 个月，42.4% 为女性）因 SFS 急诊就诊。指南之前和之后共有 49 668 (35.0%) 名儿童和 92 453 (65.1%) 名儿童。所有年龄段的腰椎穿刺率从 2005 年的 11.6%（95% CI，10.8% 至 12.4%）下降到 2019 年的 0.6%（95% CI，0.5% 至 0.8%）（P < .001 ）。头部计算机断层扫描（10.6% 至 1.6%；P < .001）、全血细胞计数（38.8% 至 10.9%；P < .001）、住院率（19.2% 至 5.2%；P < .001），以及平均成本（1523 美元到 601 美元；P< .001）。在美国儿科学会指南发布之前和之后，所有结果的减少都开始了。细菌性脑膜炎的延迟诊断没有显着变化（49 668 例中的第 2 次 [0.0040%；95% CI，0.00049% 至 0.015%]，92 453 例中的第 3 次 [0.0032%; 95% CI，0.000606% 至 0.000609% 至 0.000604%] ]；P = .99）。

诊断测试、住院和费用在研究期间有所下降，但细菌性脑膜炎的延迟诊断并未随之增加。这些数据表明，大多数患有 SFS 的儿童无需进行木材穿刺或其他诊断测试即可得到安全管理。