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Re: A self-fulfilling prophesy?

Dear Editor

Carroll and Brookfield[1] quote a widely used definition of febrile convulsion in their second paragraph: "an epileptic seizure occurring in a child aged from 6 months to 5 years, precipitated by fever arising from infection outside the nervous system in a child who is otherwise neurologically normal". The authors then go on to say that only a tiny percentage of children with febrile convulsions have meningitis. By definition though, that percentage is 0 %.

I dispute the assertion that more experienced staff are less likely to recommend lumbar punctures. Over the years, most people miss the occasional case of meningitis and become doubly wary of 'absence of meningeal signs' thereafter. Meningeal signs are often misunderstood too; many Senior House Officers believe Kernig sign to have something to do with pain in the back (rather than just a feeling of tightening in the hamstings). With neck stiffness, they sometimes and expect the neck to be rigid rather than just slightly stiff on extreme flexion.

Even viral meningitis is very good at causing sensorineural hearing loss. Unless we routinely start antibiotics and request audiology on all children who have had a convulsion with fever, we still need to do lumbar punctures.

Reference

(1) Carroll W and Brookfield D. Lumbar puncture following febrile convulsion. Arch Dis Child 2002;87: 238-240.