Abstracts

Rationale: Febrile seizure (FS) is the most common seizure disorder in children, and has higher incidence in Japan than in Western countries. The Japanese Society of Child Neurology released new guidelines for management of FS in 2015 (GL2015). GL2015 includes emergency care, application of electroencephalography, neuroimaging, prophylactic diazepam, antipyretics, drugs needing special attention, and vaccines. It is important to investigate the impact on clinical practice after publication of the guidelines. The aim of this study was to investigate the impact of GL2015 on the clinical practice of Japanese pediatricians. Methods: In September 2016, a questionnaire was sent to all 523 certified training hospitals (3 pediatricians each) of the Japan Pediatric Society and the pediatric associations in all 47 prefectures (10 private pediatricians each). The questionnaire asked about management policy in 2013-2014 and 2016 in the following situations: 1) application of lumbar puncture, blood examination, and diazepam suppository in emergency rooms after a first simple FS and 2) use of prophylactic diazepam for febrile illness in children without predictive factors of relapse (young age at onset, family history of FS, low degree of fever, brief duration from fever onset to FS) and with a history of two or three simple FSs. Differences in responses between 2013-2014 and 2016 were evaluated by contingency table analysis using the chi-square test. Results: A total of 1326 pediatricians (66.1%) answered the questionnaire; 977 belonged to certified training hospitals of the Japan Pediatric Society and 349 were private pediatricians. On the questionnaires, 725 of 1326 (54.7%) reported that their facility follows GL2015 for clinical practice. The proportion of pediatricians who performed lumbar puncture, blood examination, and diazepam suppository after a first simple FS decreased from 2013-2014 to 2016 (2.0% to 1.2%, p=0.02; 61.3% to 53.1%, p<0.001; and 51.9% to 36.7%, p<0.001, respectively). The pediatricians who used prophylactic diazepam in children with two or three simple FSs decreased from 45.6% to 31.0% and 82.4% to 65.0%, respectively (p<0.01 and p<0.001). Conclusions: GL2015 did not recommend routine lumbar puncture, blood examination, and use of diazepam suppository for FS in the emergency room, and use of prophylactic diazepam in children without predictive factors of relapse. This survey suggested that GL2015 had an impact on the clinical practice of Japanese pediatricians and helped to reduce over-examination and over-treatment. However, more than 60% of pediatricians still recommended prophylactic diazepam in children with a history of three simple FSs, even though GL2015 did not recommend it. Repeated FSs may cause anxiety in caregivers as well as pediatricians about the possibility of another relapse. It is important to assuage caregivers’ fears and provide information about the relapse rate in cases of repeated FS. The present survey provides useful information for future revisions of GL2015. Funding: No external funding was received for this study.