Children with febrile seizures do not consume excess health care resources.

BACKGROUND: Febrile seizures are benign but so terrifying for parents that they may subsequently view their affected children as "vulnerable". Children viewed as vulnerable may be brought to medical attention more frequently. We examined subsequent hospitalizations and physician visits during a 6- to 7 1/2-year period for a group of children who had participated in a case-control study of initial febrile seizures. METHODS: Individual data from a regional cohort of 75 children with a first febrile seizure and 150 febrile and 150 afebrile controls were linked to 2 comprehensive provincial health services databases-a hospital admissions/ separations database and a physician services database. RESULTS: Linkage was achieved for 98% of the study cohort, with heath care utilization data for 6 to 7 1/2 years available for 96%. Children with febrile seizures had nearly identical rates of subsequent hospitalization compared with age-matched controls (chi2 test, P = .88). An excess of day-surgery visits for primarily otolaryngologic procedures was seen for the febrile seizure patients 0 to 12 months after their initial febrile seizure (chi2 test, P < .001). During the next 6 to 7 1/2 years, the febrile seizure patients had nearly identical rates of physician visits (chi2 test, P = .15); however, they had more visits to otolaryngologists in the first 3 to 9 months after the febrile seizure (chi2 test, P < .001), but fewer visits to pediatricians during the next 1 to 4 years (chi2 test, P < .001). CONCLUSIONS: Children with febrile seizures have nearly identical rates of hospital and physician services utilization compared with controls. This supports the hypothesis that febrile seizures are benign, and that parents recover from their initial anxiety and do not consider their children vulnerable to additional illness in the years that follow.

An observational asthma study alters emergency department use: the Hawthorne effect.

The objective of this study was to document that an observational study decreases the use of the emergency department (ED) for asthma. Comparison of rates between an audit and prospective period were used at a regional referral pediatric hospital ED. A total of 526 asthma visits from February 12, 1992, to April 10, 1992, were examined in an initial audit and compared to 725 visits during a prospective study from May 16, 1993, to September 29, 1993. A physician check list for medications and follow-up plans was utilized during the prospective study. The rate of repeat visits and admissions was compared between the audit and the prospective periods. In the audit, 422 asthma patients were seen, and there were 68 repeat visits within one week of the initial visit and 153 admissions. For 29 of the 68 repeat visits there was no documentation that medication had been increased after the initial visit. No follow-up plans were recorded in 275 of the 526 visits. During the prospective period 668 children presented to the ED with asthma, and 346 were enrolled into the study on risks for repeat visits. There were 57 repeat visits and 89 admissions. The repeat visit rate during the prospective period was 9 and 8%, respectively, in the enrolled and nonenrolled subjects. The repeat visit and admission rate decreased during the prospective period as compared to during the audit by 39% (P = 0.004) and 58% (P < 0.0001), respectively. A possible explanation for the difference in admission and repeat visit rates between the audit and prospective study is that physicians' behavior may have been altered by the awareness that their behavior was being closely monitored during the study.

Which child will have a febrile seizure?

OBJECTIVE: To identify risk factors predictive of a first febrile seizure. DESIGN: Case-control study. SETTING: Regional referral pediatric hospital emergency department. PATIENTS: Seventy-five patients aged 6 months to 4 years presenting with a first febrile seizure were age-matched to two febrile and two afebrile noninfectious controls who had never had a seizure. METHODS: Telephone interview of parents. MAIN OUTCOME MEASURES: Risk factors assessed included family history of febrile or afebrile seizures, neurodevelopmental abnormality, and child-care arrangement. Analysis was done by matched case-control and logistic regression. RESULTS: Factors associated with a significant increase in risk of a first febrile seizure were febrile seizures in first-degree relative (odds ratio [OR], 4.5) or second-degree relative (OR, 3.5); neonatal discharge at 28 days or later (OR, 5.6); parental report of "slow" development (OR, 4.9); and day-care attendance (OR, 3.1). For children with two risk factors (an estimated 3% of the population), the risk of developing febrile seizures is approximately 28% (assuming a population incidence of febrile seizures of 4%).

Delayed acute measles inclusion body encephalitis in a 9-year-old girl: ultrastructural, immunohistochemical, and in situ hybridization studies.

A 9-yr-old girl developed delayed acute measles inclusion body encephalitis, which was different from subacute sclerosing panencephalitis (SSPE) in clinical course. Measles virus was demonstrated by electron microscopy, immunohistochemistry, and in situ hybridization. Contrary to the most previous reports, matrix (M) protein was present in the brain, cerebrospinal fluid, and serum and was demonstrated by Western blot analysis and in situ hybridization. The hybridization was performed by a nonradioactive digoxigenin method.