Retrospective review of the management of simple febrile convulsions at a tertiary paediatric institution

Objectives: To review the medical records of children presenting to a tertiary paediatric emergency department (ED) with febrile convulsions over a 3-year period in order to assess quality of clinical practice. Methods: The medical records of all children presenting to our ED with a discharge diagnosis of 'simple febrile convulsion' during the years 2001-03 were reviewed. Data was extracted based on the parameters of clinical presentation, diagnosis and management. Results: A total of 288 patients were identified. The patients were separated into two groups - those that were discharged from the ED and those that were admitted to the hospital. Two hundred and sixty (84%) of the children were discharged from the ED. A further 28 (15%) patients were admitted to the ward. Of the children discharged from the ED, 78% had not been seen by a medical professional in the previous 24 h, 82% were diagnosed with a viral illness and clinical examination was normal in 88% of cases. A total of 36 out of 527 (6.8%) investigations performed on this group were abnormal. Most children (85%) had no clinical indication to necessitate investigation. Almost all (91%) were treated with antipyretics. The number of inappropriate investigations was directly linked to the inexperience of the treating medical officer. Of the 28 patients admitted to the hospital, 61% were diagnosed with a viral illness. A total of 15 out of 137 (10.9%) investigations were abnormal. Sixty-one per cent of patients were admitted for less than 24 h, a further third of children for 48 h. Twenty of the 28 children had no parental education documented. None were readmitted with a simple febrile convulsion during the same illness. Conclusions: Although many children who present to the hospital with simple febrile convulsions are managed appropriately, a large number are overinvestigated and overtreated, based on the clinical experience of the treating doctor. In these cases, medical record documentation can be improved. A clinical guideline based on our local fever guideline is suggested.