ABSTRACT
Objective: To study the risk factors of first episode simple febrile seizures in children. Methods: This case control study was conducted at the pediatric department of our tertiary care hospital. Cases were children of age group 6 months to 5 years presenting with first simple febrile seizures (n=214), and Controls were children of same age group presenting with short febrile illness but without any seizures (n=214). Blood investigations were done to diagnose iron deficiency, which was diagnosed by adopting cut off of hemoglobin value <11 g/dL, serum ferritin < 12 ng/mL and red cell distribution width >15%. Other risk factors studied included age, gender, socioeconomic status, prematurity, family history of febrile seizure and epilepsy in first degree relatives, consanguinity, neonatal hospital admissions, day care attendance (for >1 mo), under nutrition, and immunization status of the child. Univariate analysis for crude odds ratio and multivariate analysis (logistic regression) was performed to study the adjusted odds ratio and independent risk factors. Results: The significant risk factors for first episode simple febrile seizure were iron deficiency [OR (95% CI) 5.78 (3.56-9.38); P=0.001], family history of febrile seizure [OR 4.31 (2.37- 7.83), P<0.001] or epilepsy [OR 4.25(2.21-8.19), P<0.001] in first degree relatives, day care attendance for >1 month [OR 4.81 (2.41-9.59), P<0.001], and prematurity at birth [OR 5.18 (2.48-10.84), P<0.001]. Conclusion: Iron deficiency, family history of febrile seizure and epilepsy in first degree relatives, day care attendance and premature birth are the risk factors for first episode simple febrile seizures in children.
ABSTRACT
Objectives: To develop and assess Pediatric AppropriatenessEvaluation Protocol for India (PAEP-India) for inter-rater reliabilityand appropriateness of hospitalization.Design: Cross-sectional study.Setting: The available PAEP tools were reviewed and adaptedfor Indian context by ten experienced pediatricians followingsemi-Delphi process. Two PAEP-India tools; newborn (?28 days)and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness ofadmission and inter-rater reliability between assessors.Participants: Two sets of case records were used: (i) 274cases from five medical colleges in Delhi-NCR [?28 days (n=51);>28 days to 18 years (n=223)]; (ii) 622 infants who werehospitalized in 146 health facilities and were part of a cohort (n=30688) from two southern Indian states.Interventions: Each case-record was evaluated by twopediatricians in a blinded manner using the appropriate PAEP-India tools, and ‘admission criteria’ were categorized asappropriate, inappropriate or indeterminate.Main outcome measures: The proportion of appropriatehospitalizations and inter-rater reliability between assessors(using kappa statistic) were estimated for the cases.Results: 97.8% hospitalized cases from medical colleges werelabelled as appropriate by both reviewers with inter-rateragreement of 98.9% (k=0.66). In the southerm Indian set ofinfants, both reviewers labelled 80.5% admissions as appropriatewith inter-rater agreement of 96.1% (k= 0.89).Conclusions: PAEP-India (newborn and child) tools are simple,objective and applicable in diverse settings and highly reliable.These tools can potentially be used for deciding admissionappropriateness and hospital stay and may be evaluated later forusefulness for cost reimbursements for insurance proposes.