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Guideline Summary NGC-8181

Guideline Title

Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures.

Bibliographic Source(s) clinical Steering practice Committee guideline on Quality for the Improvement long-term management and Management, of the child Subcommittee with simple on febrile Febrile seizures. Seizures. Pediatrics Febrile seizures: 2008

Jun;121(6):1281-6. PubMed

NGC banner Guideline Summary NGC-8181 Guideline Title Febrile seizures: clinical practice guideline for the long-term managementPubMed Guideline Status This is the current release of the guideline. This seizures. guideline American updates Academy a previous of Pediatrics. version: Committee Practice parameter: on Quality long-term Improvement, treatment Subcommittee of the child on with Febrile simple Seizures. febrile Pediatrics 1999 Jun;103(6 Pt 1):1307-9. [17 references] All reaffirmed, clinical reports revised, from or retired the American at or before Academy that of time. Pediatrics automatically expire 5 years after publication unless Scope Disease/Condition(s) Simple febrile seizure Note : Simple febrile seizures are defined as brief (<15-minute) generalized seizures that occur once during a 24-hour period in a febrile child who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. Guideline Category Assessment of Therapeutic Effectiveness Management Risk Assessment Treatment Clinical Specialty Emergency Medicine Family Practice Neurology Pediatrics Intended Users Physicians Guideline Objective(s) To antipyretics address the in children risks and with benefits simple of febrile both continuous seizures and intermittent anticonvulsant therapy as well as the use of Target Population Febrile or history children of afebrile between seizures the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance, Interventions and Practices Considered 1. Continuous anticonvulsant therapy with agents such as phenobarbital, primidone, valproic acid or carbamazepine (considered, but not recommended) 2. Intermittent therapy with diazepam (considered, but not recommended) 3. Antipyretic therapy (considered, but not recommended) Major Outcomes Considered l Recurrence of seizures l Adverse effects of treatment options " id="pdf-obj-0-31" src="pdf-obj-0-31.jpg">

Guideline Status

This is the current release of the guideline. This seizures. guideline American updates Academy a previous of Pediatrics. version: Committee Practice parameter: on Quality long-term Improvement, treatment Subcommittee of the child on with Febrile simple Seizures. febrile

Pediatrics 1999 Jun;103(6 Pt 1):1307-9. [17 references] All reaffirmed, clinical reports revised, from or retired the American at or before Academy that of time. Pediatrics automatically expire 5 years after publication unless

Scope

Disease/Condition(s)

Simple febrile seizure

Note: Simple febrile seizures are defined as brief (<15-minute) generalized seizures that occur once during a 24-hour period in a febrile child who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures.

Guideline Category

Assessment of Therapeutic Effectiveness

Management

Risk Assessment

Treatment

Clinical Specialty

Emergency Medicine

Family Practice

Neurology

Pediatrics

Intended Users

Physicians

Guideline Objective(s)

To antipyretics address the in children risks and with benefits simple of febrile both continuous seizures and intermittent anticonvulsant therapy as well as the use of

Target Population

Febrile or history children of afebrile between seizures the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance,

Interventions and Practices Considered

  • 1. Continuous anticonvulsant therapy with agents such as phenobarbital, primidone, valproic acid or carbamazepine

(considered, but not recommended)

  • 2. Intermittent therapy with diazepam (considered, but not recommended)

  • 3. Antipyretic therapy (considered, but not recommended)

Major Outcomes Considered

  • l Recurrence of seizures

Methodology

Methods Used to Collect/Select the Evidence

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

focused basis addressing A comprehensive of on a systematic possible both the review therapeutic efficacy grading of the and of evidence-based interventions the potential quality adverse of in evidence literature the effects management and published of strength the proposed of since children of recommendations. 1998 treatments. with was simple conducted Decisions febrile with seizures. were the made aim The of on review the

Number of Source Documents

simple reviewed In the original febrile and abstracted seizures practice or parameter, for the the therapy update. more of these than 300 seizures medical were journal reviewed articles and reporting abstracted. studies An additional of the natural 65 articles history were of

Methods Used to Assess the Quality and Strength of the Evidence

Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Evidence Quality A: Well-designed randomized controlled trials (RCTs) or diagnostic studies on relevant populations B: RCTs or diagnostic studies with minor limitations; overwhelmingly consistent evidence from observational studies C: Observational studies (case-control and cohort design) D: Expert opinion, case reports, reasoning from first principles X: harm Exceptional situations which validating studies cannot be performed and there is a clear preponderance of benefit or

Methods Used to Analyze the Evidence

Systematic Review with Evidence Tables

Description of the Methods Used to Analyze the Evidence

Emphasis was placed on articles that differentiated simple febrile seizures from other types of seizures, that carefully

from matched based the can treatment 65 be articles found and in that a control forthcoming best fit groups, these technical criteria. and that report A described more (the comprehensive initial adherence technical to review the report drug of can the regimen. literature be accessed Tables on at which were constructed this report is

Methodology Methods Used to Collect/Select the Evidence Searches of Electronic Databases Description of Methods Used tohttp://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/6/e86 ). (See also "Availability of Companion Documents" field in this summary.) Methods Used to Formulate the Recommendations Expert Consensus Description of Methods Used to Formulate the Recommendations To Academy neurologist update of the and Pediatrics clinical consisted practice (AAP) of reconvened a guideline neuroepidemiologist, on the the Subcommittee treatment 2 additional of on children Febrile child with neurologists, Seizures. simple The febrile and committee a seizures, practicing was the chaired pediatrician. American by a child The served were intermittent AAP (1) as established effectiveness a major anticonvulsant source a partnership of continuous of therapy information with in anticonvulsant preventing the for University these recurrent practice-guideline therapy of Kentucky febrile in preventing (Lexington, seizures, recommendations. recurrent (3) KY) effectiveness to febrile develop The seizures, specific of an antipyretics evidence issues (2) effectiveness report, addressed in which of preventing therapy. recurrent febrile seizures, and (4) adverse effects of either continuous or intermittent anticonvulsant Evidence-based anticipated identified, The evidence-based appraised, with recommendations the approach recommendation and summarized to guideline reflect is and followed. the development that quality an explicit of evidence requires link between that and the the evidence balance evidence of and in benefit support recommendations and of harm a recommendation that be is defined. be AAP of recommendations policy statement (see "Classifying "Availability Recommendations of Companion Documents" for Clinical Practice field). Guidelines" was followed in designating levels Rating Scheme for the Strength of the Recommendations Guideline Definitions for Evidence-Based Statements Clinicians should follow a strong A strong recommendation in favor of a particular action is made when the anticipated Strong Implication Definition Statement " id="pdf-obj-1-49" src="pdf-obj-1-49.jpg">

). (See also "Availability of Companion

Documents" field in this summary.)

Methods Used to Formulate the Recommendations

Expert Consensus

Description of Methods Used to Formulate the Recommendations

To Academy neurologist update of the and Pediatrics clinical consisted practice (AAP) of reconvened a guideline neuroepidemiologist, on the the Subcommittee treatment 2 additional of on children Febrile child with neurologists, Seizures. simple The febrile and committee a seizures, practicing was the chaired pediatrician. American by a child

The served were intermittent AAP (1) as established effectiveness a major anticonvulsant source a partnership of continuous of therapy information with in anticonvulsant preventing the for University these recurrent practice-guideline therapy of Kentucky febrile in preventing (Lexington, seizures, recommendations. recurrent (3) KY) effectiveness to febrile develop The seizures, specific of an antipyretics evidence issues (2) effectiveness report, addressed in which of

preventing therapy. recurrent febrile seizures, and (4) adverse effects of either continuous or intermittent anticonvulsant

Evidence-based anticipated identified, The evidence-based appraised, with recommendations the approach recommendation and summarized to guideline reflect is and followed. the development that quality an explicit of evidence requires link between that and the the evidence balance evidence of and in benefit support recommendations and of harm a recommendation that be is defined. be

AAP of recommendations policy statement (see "Classifying "Availability Recommendations of Companion Documents" for Clinical Practice field). Guidelines" was followed in designating levels

Rating Scheme for the Strength of the Recommendations

Guideline Definitions for Evidence-Based Statements

Clinicians should follow a strong

A strong recommendation in favor of a particular action is made when the anticipated

Strong

Implication Definition Statement
Implication
Definition
Statement

impossible to obtain and the anticipated benefits strongly outweigh the harms.

and recommendation alternative compelling approach rationale unless is present. a for clear an

benefits) circumstances, recommendation and the strong against quality recommendations of an the action supporting is made may evidence when be made the is anticipated when excellent. high-quality In harms some clearly evidence clearly exceed identified is the

benefits of the recommended intervention clearly exceed the harms (as a strong

recommendation

Recommendation

exceed A recommendation the harms but in favor the quality of a particular of evidence action is not is made as strong. when Again, the anticipated in some clearly benefits

identified impossible circumstances, to obtain but the recommendations anticipated benefits may be outweigh made when the harms. high-quality evidence is

Clinicians follow a recommendation would be prudent but to

should information patient remain preferences and alert sensitive to new to

harm.

Clinicians published the balance should evidence of benefit be that alert versus clarifies to new

No the recommendation anticipated balance indicates of benefits that there and harms is a lack is presently of pertinent unclear. published evidence and that

No recommendation

and a option Clinicians substantial patient in their should preference role. decision-making, consider may the have

Options carefully define performed courses studies that have may be shown taken little when clear either advantage the quality to 1 of approach evidence over is suspect another. or

Option

Note: Figure 1 in the original guideline document illustrates the integration of evidence-quality appraisal with an assessment of the anticipated balance between benefits and harms to designate a policy as a strong recommendation, recommendation, option, or no recommendation.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

External Peer Review

Internal Peer Review

Description of Method of Guideline Validation

The guideline was reviewed by members of the American Academy of Pediatrics (AAP) Steering Committee on Quality

Medicine Developmental Improvement and Medical and and Management; Behavioral Liability and Pediatrics, members Risk Management; and of the Epidemiology; AAP Sections members members on of Neurology, the AAP of the Councils Pediatric AAP Committees on Emergency Children on With Medicine, Pediatric Disabilities Emergency and

Community Academy of Pediatrics; Neurology. and members of outside organizations including the Child Neurology Society and the American

Recommendations

Major Recommendations

On therapy the basis is recommended of the risks and for children benefits with of the 1 or effective more simple therapies, febrile neither seizures. continuous nor intermittent anticonvulsant

  • l Aggregate evidence quality: B (randomized, controlled trials and diagnostic studies with minor limitations).

  • l Benefit: prevention of recurrent febrile seizures, which are not harmful and do not significantly increase the risk

for development of future epilepsy.

  • l Harm: adverse effects including rare fatal hepatotoxicity (especially in children younger than 2 years who are also

reactions masking pancreatitis at greatest an with risk evolving with phenobarbital; of valproic febrile central seizures), acid nervous lethargy, and hyperactivity, thrombocytopenia, system drowsiness, infection. irritability, and weight ataxia lethargy, loss for intermittent and sleep gain, disturbances, gastrointestinal diazepam and as well disturbances, hypersensitivity as the risk and of

  • l Benefits/harms assessment: preponderance of harm over benefit.

  • l Policy level: recommendation. Definitions:

Guideline Definitions for Evidence-Based Statements

and alternative compelling approach rationale is present. for an

Recommendation

A recommendation in favor of a particular action is made when the anticipated benefits

exceed identified impossible the circumstances, to harms obtain but but the the recommendations quality anticipated of evidence benefits may is be not outweigh made as strong. when the harms. Again, high-quality in some evidence clearly is

Clinicians follow a recommendation would be prudent but to

should information patient remain preferences and alert sensitive to new to

Option

Options define courses that may be taken when either the quality of evidence is suspect or

Clinicians should consider the

Strong recommendation

A benefits strong of recommendation the recommended in favor intervention of a particular clearly action exceed is the made harms when (as the a strong anticipated

benefits) recommendation circumstances, and the strong against quality recommendations of an the action supporting is made may evidence when be made the is anticipated when excellent. high-quality In harms some clearly evidence clearly exceed identified is the

Clinicians recommendation should follow unless a a strong clear

impossible to obtain and the anticipated benefits strongly outweigh the harms.

Statement Definition Implication
Statement
Definition
Implication

and a option substantial patient in their preference role. decision-making, may have

carefully performed studies have shown little clear advantage to 1 approach over another.

No recommendation

No the recommendation anticipated balance indicates of benefits that there and harms is a lack is presently of pertinent unclear. published evidence and that

Clinicians published the balance should evidence of benefit be that alert versus clarifies to new

harm.

Note: Figure 1 in the original guideline document illustrates the integration of evidence-quality appraisal with an assessment of the anticipated balance between benefits and harms to designate a policy as a strong recommendation, recommendation, option, or no recommendation.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for the recommendation (see "Major Recommendations").

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

  • l Optimizing practitioner understanding of the scientific basis for using or avoiding various proposed treatments for

children with simple febrile seizures

  • l Improving the health of children with simple febrile seizures by avoiding therapies with high potential for adverse

effects and no demonstrated ability to improve children's long-term outcomes

  • l Reducing costs by avoiding therapies that will not demonstrably improve children's long-term outcomes

  • l Helping the practitioner educate caregivers about the low risks associated with simple febrile seizures

Potential Harms

Not stated

Qualifying Statements

Qualifying Statements

therapeutic This guideline interventions is designed in to this assist patient pediatricians population. by providing It is not intended an analytic to replace framework clinical for decisions judgment regarding or to establish possible a

protocol for all patients with this disorder. Rarely will these guidelines be the only approach to this problem.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)

clinical Steering practice Committee guideline on Quality for the Improvement long-term management and Management, of the child Subcommittee with simple on febrile Febrile seizures. Seizures. Pediatrics Febrile seizures: 2008

Jun;121(6):1281-6. PubMed

and a option substantial patient in their preference role. decision-making, may have carefully performed studies havePubMed " id="pdf-obj-3-118" src="pdf-obj-3-118.jpg">

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

1999 Jun (revised 2008 Jun)

Guideline Developer(s)

American Academy of Pediatrics - Medical Specialty Society

Source(s) of Funding

American Academy of Pediatrics

Guideline Committee

Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures

Composition of Group That Authored the Guideline

Subcommittee Methodologist; on Peter Febrile Berman, Seizures, MD; John 20022008: L. Green, Patricia MD; Sanford K. Duffner, Schneider, MD, Chairperson; MD Robert J. Baumann, MD,

Gordon Steering Moyer, MD, B. Committee Glade, MPH; MD; Xavier on Norman Quality D. Sevilla, "Chip" Improvement MD; Harbaugh, Lisa Simpson, and Jr, Management, MD; MB, Thomas BCh, 20072008: MPH; K. McInerny, Glenn S. Elizabeth MD; Takata, Marlene S. MD Hodgson, R. Miller, MD, MD, Chairperson; MSc; Virginia A.

Liaisons: Epidemiology; Denise Ellen Dougherty, Schwalenstocker, PhD, Agency MBA, for National Healthcare Association Research of and Children's Quality; Hospitals Daniel R. and Neuspiel, Related MD, Institutions Section on Staff: Caryn Davidson, MA

Financial Disclosures/Conflicts of Interest

All interest panel form. members reviewed and signed the American Academy of Pediatrics (AAP) voluntary disclosure and conflict-of-

Guideline Status

This is the current release of the guideline. This seizures. guideline American updates Academy a previous of Pediatrics. version: Committee Practice parameter: on Quality long-term Improvement, treatment Subcommittee of the child on with Febrile simple Seizures. febrile

Pediatrics 1999 Jun;103(6 Pt 1):1307-9. [17 references] All reaffirmed, clinical reports revised, from or retired the American at or before Academy that of time. Pediatrics automatically expire 5 years after publication unless

Guideline Availability

Electronic copies: Available from the American Academy of Pediatrics (AAP) Policy Web site

Adaptation Not applicable: The guideline was not adapted from another source. Date Released 1999 Jun (revisedAmerican Academy of Pediatrics (AAP) Policy Web site . Print Village, copies: IL 60009-0927. Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Availability of Companion Documents The following are available: l Baumann RJ. Technical report: treatment of the child with simple febrile seizures. Pediatrics 1999 Jun;103(6). Available from the American Academy of Pediatrics Policy Web site . l Classifying recommendations for clinical practice. Policy statement. Pediatrics 2004 Sept;114(3). Available from the American Academy of Pediatrics Policy Web site . Print Village, copies: IL 60009-0927. Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Patient Resources None available NGC Status This December summary 15, 1999. was completed This summary by ECRI was on updated August by 29, ECRI 1999. Institute The information on February was 24, verified 2011. by the guideline developer on " id="pdf-obj-4-81" src="pdf-obj-4-81.jpg">

. Print Village, copies: IL 60009-0927. Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove

Availability of Companion Documents

The following are available:

  • l Baumann RJ. Technical report: treatment of the child with simple febrile seizures. Pediatrics 1999 Jun;103(6).

.
.
  • l Classifying recommendations for clinical practice.

Policy statement. Pediatrics 2004 Sept;114(3). Available from

Adaptation Not applicable: The guideline was not adapted from another source. Date Released 1999 Jun (revisedAmerican Academy of Pediatrics (AAP) Policy Web site . Print Village, copies: IL 60009-0927. Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Availability of Companion Documents The following are available: l Baumann RJ. Technical report: treatment of the child with simple febrile seizures. Pediatrics 1999 Jun;103(6). Available from the American Academy of Pediatrics Policy Web site . l Classifying recommendations for clinical practice. Policy statement. Pediatrics 2004 Sept;114(3). Available from the American Academy of Pediatrics Policy Web site . Print Village, copies: IL 60009-0927. Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Patient Resources None available NGC Status This December summary 15, 1999. was completed This summary by ECRI was on updated August by 29, ECRI 1999. Institute The information on February was 24, verified 2011. by the guideline developer on " id="pdf-obj-4-105" src="pdf-obj-4-105.jpg">

. Print Village, copies: IL 60009-0927. Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove

Patient Resources

None available

NGC Status

This December summary 15, 1999. was completed This summary by ECRI was on updated August by 29, ECRI 1999. Institute The information on February was 24, verified 2011. by the guideline developer on

Copyright Statement

This restrictions. Elk Grove NGC summary Village, Please IL contact is 60007. based the on Permissions the original guideline, Editor, American which is Academy subject to of Pediatrics the guideline (AAP), developer's 141 Northwest copyright Point Blvd,

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