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Seizures and Fever: Can We Rule Out Meningitis on Clinical Grounds Alone?

Department of Pediatrics University Hospital Rotterdam/Sophia Children's Hospital, Center for Clinical Decision Analysis, Room EE 2171, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

Auke Beishuizen, M.D.

Department of Pediatrics University Hospital Rotterdam/Sophia Children's Hospital

Gerarda Derksen-Lubsen, M.D., Ph.D.

Department of Pediatrics University Hospital Rotterdam/Sophia Children's Hospital

Jacobus Lubsen, M.D., Ph.D.

Center for Clinical Decision Analysis, Academic Hospital and Medical Faculty Erasmus University, Rotterdam, The Netherlands

A study was done of 309 children seen in two ERs with a first seizure and fever to assess whether meningitis could be recognized using readily available clinical information. Among these children, 23 (7%) cases of meningitis were diagnosed. A group of 69 children with seizures and fever but no meningitis served as controls. Signs from ER examinations that discriminated between children with and those without meningitis were: petechiae, nuchal rigidity, coma, persistent drowsiness, ongoing convulsions, and paresis or paralysis; 21 cases were thus identified. Two children with a suspicious history but none of these signs proved to have meningitis. Children whose seizures showed no complex features and whose febrile illness revealed no suspicious features did not have meningitis. Our results indicate that based on available clinical data, meningitis can be ruled out in children presenting with seizures and fever; thus, there is no need for routine investigation of cerebrospinal fluid.

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