Seizing the Evidence: Audit of Simple Febrile Seizure Treatment Practices

Introduction: Febrile seizures (FS) are the most common seizure disorder in childhood, typically affecting children between 6 months to 6 years. They are defined as seizures associated with fever in the absence of central nervous system infection or acute metabolic disturbance. Global incidence ranges from 2–5% in Europe and the United States, with higher rates reported in Asia and the Pacific. Simple febrile seizures (SFS) are characterised by a generalised tonic–clonic seizure lasting less than 15 minutes, occurring once in 24 hours, and without focal neurological features. Although SFS are benign and self-limiting, distressing to caregivers, leading to unnecessary hospital admissions, investigations, and resource utilisation. The Royal Children’s Hospital (RCH) guideline recommends conservative management, limited investigations, and safe discharge with appropriate parental education. This audit aimed to compare management practices for SFS in University Hospital Limerick (UHL) with RCH standards. Aim: To assess the management of children presenting with SFS in UHL Paediatric Emergency Department and compare local compliance with RCH guidelines. Methodology: A retrospective audit was conducted over three months (1st November 2022–31st January 2023) and electronic health records was reviewed. Children aged 6 months–6 years with SFS were included. Exclusions were complex/afebrile seizures, sepsis, meningitis or age outside criteria. Investigations and management was assessed against RCH guidelines. Results: A total of 49 patients were included: 24 males (49%) and 25 females (51%). Nasopharyngeal swabs (NPS): 38/49 (78%) performed; 32/38 (84%) positive. Pathogens: influenza 9/32 (28%), adenovirus 6/32 (19%), RSV 4/32 (13%), parainfluenza 2/32 (6%), rhino/enterovirus 3/32 (9%), SARS-CoV-2 3/32 (9%), mixed 5/32 (16%). Source of infection: URTI 17/49 (35%), chest 12/49 (25%), throat 11/49 (22%), UTI 3/49,viral 2/49 (4%), ear 1/49 (2%), undetermined 1/49 (2%). Blood tests: 42/49 (86%) performed of which 22/42 (52%) had raised inflammatory markers. Chest X-rays: 24/49 (49%); viral 6/24 (25%), normal 12/24 (50%), pneumonia 6/24 (25%). Admissions: 40/49 (82%); of which 11/40 (27%) met criteria. EEG: 13/49 (27%); abnormal 10/13 (77%). MRI: 4/49 (8%); 3 normal, 1 abnormal. Seizure history: First episode 22/49 (45%); multiple 11/49 (23%) remaining undocumented and a proper record was not available Discussion: This audit shows over reliance on investigations and admissions in the assessment of SFS compared with RCH recommendations. Most children had blood drawn and chest X-rays with limited diagnostic value, and admission rates were disproportionately high. Evidence confirms SFS are benign and self-limiting, yet parental anxiety often drives unnecessary intervention. To address this, a local clinical pathway will be introduced, emphasising supportive care, 1–2 hours observation with neurological checks, and avoidance of unnecessary tests. A parent information leaflet will support parental reassurance, support parent decision making, and prevent repeat attendances. These measures aim to standardise care, improve resource utilisation, and enhance outcomes. A re-audit will be undertaken following pathway implementation to measure improvement and close the audit loop.