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A Decision Analysis Approach

Alain Joffe, MD; Marie McCormick, MD, ScD; Catherine DeAngelis, MD, MPH

Am J Dis Child. 1983;137(12):1153-1156.

Abstract
• Whether all children brought to the emergency room with a first seizure and fever require lumbar puncture (LP) remains controversial. We reviewed the emergency room records of 241 children aged 6 months to 6 years who had this clinical picture. Five history and physical examination items discriminated between children with and without meningitis: a physician visit within 48 hours before the seizure; the occurrence of convulsions on arrival at the emergency room; a focal seizure; suspicious findings on physical and/or neurologic examination. Used in combination, these items (risk factors) identified all children with meningitis but would have spared 62% of children without meningitis the need for LP. In a decision analysis framework, they were as sensitive but more specific than LP in detecting children with meningitis. Most important, their negative predictive value was 100%.

(Am J Dis Child 1983;137:1153-1156)

Author Affiliations
From the Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore (Drs Joffe and DeAngelis); and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia (Dr McCormick).

Footnotes
Read before the Ambulatory Pediatric Association, Washington, DC, May 5, 1983.

Reprint requests to Park 207, Johns Hopkins Medical Institutions, Baltimore, MD 21205 (Dr Joffe).

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