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

History and Physical

The history and physical exam in children with febrile seizures should focus on both the seizure event and their febrile illness. Children therefore need a full neurologic exam in addition to looking for a source of fever.

History	Details around seizure Characteristics, duration, number Focal features Medications given Known fever: duration and height Other associated symptoms Hydration status Trauma history
Past Medical History	Immunizations Previous febrile seizure Neurologic disease Developmental delay Immunosuppression Medications Family history of febrile seizures or epilepsy
Physical Exam	VS General appearance, mental status Detailed exam for fever source, including signs of head/neck or intracranial infection Signs of trauma/abuse Detailed neurologic exam to identify presence of focal signs; often need reassessments as children may initially be postictal Complete PE to identify source of infection

Evaluation

Routine laboratory testing, neurologic imaging and EEG are not recommended per
AAP Guidelines.

AAP Guidelines for Febrile Seizure
Care is guided by history and physical exam
Laboratory testing should focus on age-appropriate fever evaluation guided by history and physical exam
- ED Influenza/Flu Pathway
- Fever Pathway
Consider POC glucose if child has not returned to baseline mental status
Assess for meningitis, intracranial, head or neck infection
- In the ED, decision to perform an LP is determined by the history and physical examination of the individual child
- Per the AAP Guidelines, the following populations may be at increased risk for meningitis:
  - Age < 12 mos and not adequately immunized with Prevnar and HiB
  - Pre-treated with antibiotics

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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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.

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

History and Physical

Evaluation

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

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

History and Physical

Evaluation