• Moses Laman, Laurens Manning, Ilomo Hwaiwhange, John Vince, Susan Aipit, Trevor Mare, Jonathan Warrel, Harin Karunajeewa, Peter Siba, Ivo Mueller, and Timothy M E Davis.
• Papua New Guinea Institute of Medical Research, Modilon General Hospital, Madang, Papua New Guinea.
• Clin. Infect. Dis. 2010 Sep 1;51(5):534-40.

BackgroundAlthough routine lumbar puncture (LP) is often recommended as part of the assessment of fever-associated seizures in children, accumulating evidence questions its value and reveals a decrease in its frequency. Our primary hypothesis was that children who present with a single seizure but with no clinical signs of meningism or coma do not require LP as part of initial diagnostic assessment.MethodsWe prospectively followed up 377 children aged 2 months through 10 years who presented with at least 1 fever-associated seizure to Modilon Hospital, Madang, Papua New Guinea, from November 2007 through July 2009. Clinical management was performed by hospital staff according to national pediatric guidelines.ResultsOf 188 children with a single seizure and 189 children with multiple seizures, 139 (73.9%) and 154 (81.5%), respectively, underwent a LP as part of their initial assessment. Of the 130 children with a single seizure but no evidence of meningism (ie, neck stiffness, positive Kernig's or Brudzinski's sign, and bulging fontanelle) or coma (Blantyre Coma Score 2), none (95% confidence interval, 0%-3.6%) had proven or probable acute bacterial meningitis, and only 1 patient had viral encephalitis (subacute sclerosing panencephalitis). Eighty-one of these children (62.3%) had a final diagnosis of a simple febrile seizure. Proven or probable acute bacterial meningitis was more common in children with a single seizure and meningism or coma (10; 17.2%) and in those with multiple seizures without or with meningism or coma (2 [2.0%] and 30 [33.7%], respectively).ConclusionsInitial LP is unnecessary when careful clinical assessment indicates features of a simple febrile seizure.

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