Complex febrile seizures

The AAP came out with guidelines for simple febrile seizures back in 2011, but there are no standardized recommendations for complex febrile seizures. This is a large review of resource utilization over the last 15+ years across 36 tertiary-care pediatric hospitals. The review included nearly 18,000 patients and analyzed trends divided between 3 time frames: 2009-2011, 2011-2016, 2016-2021. Here are the highlights:

• overall there was a decrease in admissions, testing (labs, imaging, and EEG), and antimicrobial use without an increase in "serious" diagnoses or hospital re-admissions 
• there was significant variation across hospitals in terms of resource utilization
• other studies have supported decreased resource utilization and have importantly noted that "all patients with abnormal imaging had other clinical signs that would suggest this pathology" and "the vast majority of patients with intracranial infections have other clinical signs pointing to this diagnosis..."

Bottom line: decreased resource utilization with no increased re-admissions and no increased "serious" diagnoses to me says complex febrile seizure does not ALWAYS require labs, imaging, or even admission. A thorough H&P should guide your decision making as most kids with a serious infection or other intracranial pathology will demonstrate findings to suggest these diagnoses. ​