Establishment of Achievable Benchmarks of Care in the Neurodiagnostic Evaluation of Simple Febrile Seizures

Overview

Journal J Hosp Med

Publisher Wiley

Specialties General Medicine
Health Services

Date 2022 May 13

PMID 35560723

Authors

John R Stephens

Matt Hall

Matthew J Molloy

Jessica L Markham

Jillian M Cotter

Michael J Tchou

Paul L Aronson

Michael J Steiner

Elisha McCoy

Megan E Collins

Samir S Shah

Affiliations

Soon will be listed here.

Abstract

Background: Current guidelines recommend against neurodiagnostic testing for the evaluation of simple febrile seizures.

Objectives: (1) Assess overall and institutional rates of neurodiagnostic testing and (2) establish achievable benchmarks of care (ABCs) for children evaluated for simple febrile seizures at children's hospitals.

Design, Setting, And Participants: Cross-sectional study of children 6 months to 5 years evaluated in the emergency department (ED) 2016-2019 with simple febrile seizures at 38 children's hospitals in Pediatric Health Information System database. We excluded children with epilepsy, complex febrile seizures, complex chronic conditions, and intensive care.

Outcome Measures: Proportions of children who received neuroimaging, electroencephalogram (EEG), or lumbar puncture (LP) and rates of hospitalization for study cohort and individual hospitals. Hospital-specific outcomes were adjusted for patient demographics and severity of illness. We utilized hospital-specific values for each measure to calculate ABCs.

Results: We identified 51,015 encounters. Among the study cohort 821 (1.6%) children had neuroimaging, 554 (1.1%) EEG, 314 (0.6%) LP, and 2023 (4.0%) were hospitalized. Neurodiagnostic testing rates varied across hospitals: neuroimaging 0.4%-6.7%, EEG 0%-8.2%, LP 0%-12.7% in patients <1-year old and 0%-3.1% in patients ≥1 year. Hospitalization rate ranged from 0%-14.5%. Measured outcomes were higher among hospitalized versus ED-only patients: neuroimaging 15.3% versus 1.0%, EEG% 24.7 versus 0.1% (p < .001). Calculated ABCs were 0.6% for neuroimaging, 0.1% EEG, 0% LP, and 1.0% hospitalization.

Conclusions: Rates of neurodiagnostic testing and hospitalization for simple febrile seizures were low but varied across hospitals. Calculated ABCs were 0%-1% for all measures, demonstrating that adherence to current guidelines is attainable.

Citing Articles

Changing patterns of routine laboratory testing over time at children's hospitals.

Tchou M, Hall M, Markham J, Stephens J, Steiner M, McCoy E J Hosp Med. 2024; 19(8):671-679.

PMID: 38643414 PMC: 11296890. DOI: 10.1002/jhm.13372.

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