No Sense Making Sense of State v Messenger

To the Editor. One of the areas of controversy in the practice of pediatric emergency medicine is the evaluation of the infant who presents with its first febrile seizure. I applaud the American Academy of Pediatrics (AAP) Provisional Committee on Quality Improvement's attempt to clarify the issues regarding the treatment of these infants. I must, however, question both the recommendations and the methods by which they were developed. Whenever a committee of the AAP presents practice parameters, recommendations must reflect the practice patterns of the medical community and the state of the art scientific evidence available to substantiate the recommendation. The Committee recommends “after the first seizure with fever in infants younger than 12 months, performance of a lumbar puncture must be strongly considered.” Neither the prevailing practice patterns of pediatric emergency physicians nor the most recent literature were considered. The makeup of the Committee as listed in the abstract lists general pediatricians and consultants in the field of neurology and epilepsy as the developers of this practice parameter. Absent from the Subcommittee on Febrile Seizures was any representation from the Section on Pediatric Emergency Medicine. The references used to support this recommendation cannot be considered contemporary. The most recent article quoted in references substantiating this recommendation is 13 years old. Pediatric emergency physicians manage fevers with seizures as a daily part of their clinical practice.1 If …