Febrile Seizures without Neurologic Disease Clinical Pathway — Emergency Department, Inpatient, Outpatient Specialty Care and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Related Pathways

Active Seizure
- Activate Emergency Response
- Anti-seizure medications, if applicable
- Monitor and support ABCs
- ED, UC: Status Epilepticus

Febrile Seizure General Information

Child with Febrile Seizure

ED Triage

Consider transfer to ED from UC or Outpatient
- Multiple seizures the day of encounter
- Child not back to baseline

Team Assessment

History and Physical
- Full neurological exam
- Assess for meningitis/intracranial/head or neck infection
Evaluation
- Identify fever source, workup as indicated
- For well appearing children with a
  non-focal exam, routine labs, neuroimaging and EEG are not indicated

Simple Febrile Seizure
- ≤ 15 mins duration
- No focal features
- Single seizure in 24 hrs

Complex Febrile Seizure
- > 15 mins in duration
- Focal features
- ≥ 2 seizures in 24 hrs

Consider Neurology Consult in ED

Prolonged post-ictal focal deficits, including suspected Todd’s Paralysis, >15 mins
Hemiclonic seizures: focal rhythmic jerking that do not secondarily generalize
Seizure > 15 mins or treated acutely prior to 15 min
Failure to return to baseline mental status
≥ 3 seizures in < 24 hrs

Disposition

Discharge

Admission Considerations

Return to neurological baseline
Well-appearing, tolerating PO
Fever source does not
require further evaluation
or inpatient treatment
Parental concerns addressed
Follow-up plan established

Inpatient Evaluation

Discharge

Neurology referral
Discharge criteria
Instructions
Seizure medications

Posted: July 2024

Authors:
- J. Hart, MD;
- M. Blackstone, MD;
- C. Press, MD;
- V. Scheid, MD;
- T. Kaur, MD;
- S. Haas, MD;
- P. Mcdonnell, MD;
- L. Fried, MD;
- J. Katz, MD;
- K. Murphy, DO;
- G. Murray, MD

Editors: Clinical Pathways Team

References

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Emergency Department, Inpatient, Outpatient Specialty Care and Primary Care Clinical Pathway for Children with Febrile Seizures without Neurologic Disease

References

Emergency Department, Inpatient, Outpatient Specialty Care and Primary Care Clinical Pathway for Children with
Febrile Seizures without Neurologic Disease