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Meta-Analysis
. 2022 Jun;181(6):2201-2213.
doi: 10.1007/s00431-022-04431-w. Epub 2022 Mar 16.

The baseline risk of multiple febrile seizures in the same febrile illness: a meta-analysis

Christopher Henry  1 , Chelsea Cockburn  2   3 , Mary Helen Simpson  2   4 , Serenity Budd  5 , Chen Wang  5 , Darina Dinov  6
Affiliations
Meta-Analysis

The baseline risk of multiple febrile seizures in the same febrile illness: a meta-analysis

Christopher Henry et al. Eur J Pediatr. 2022 Jun.

Abstract

The baseline risk for multiple febrile seizures within the same febrile illness is largely unknown. Estimates range from 5 to 30%. Imprecise estimates can lead to incorrectly powering studies investigating the management of febrile seizures. To estimate the risk of multiple febrile seizures in the same febrile illness, we systematically reviewed and conducted a meta-analysis of studies from January 2000 to December 2021 that contained data for the number of children for both simple and complex febrile seizures in the same febrile illness. We searched MEDLINE, EMBASE, and Web of Science for randomized, quasi-randomized, prospective, and retrospective trials that involved children with febrile seizures. A total of 23,131 febrile illnesses with febrile seizures met the inclusion criteria. The estimated baseline risk of multiple febrile seizures in the same febrile illness was 17% (95% CI, 16-19%). However, the 30 cohorts that included both admitted and non-admitted patients had a lower percentage of multiple FSs within the same illness (14%; 95% CI, 12-15%) than the 30 cohorts that enrolled only admitted patients (20%; 95% CI, 16-25%).

Conclusion: Researchers can use estimates in this paper to design future studies. Taking into the account the substantial heterogeneity between countries and studies, clinicians could cautiously use our estimates in their clinical assessment and be better able to set parental expectations about a child's chances of having another febrile seizure during the current illness.

Trial registration: PROSPERO CRD42020191784. Registered July 18, 2020.

What is known: • There is renewed interest in the diagnostic workup and prophylactic treatment of febrile seizures to prevent repeat seizures in the same febrile illness. • There is a lack of accurate estimates of the baseline risk for multiple febrile seizures in the same illness to properly design studies investigating management.

What is new: • This study provides the most robust estimates for the baseline risk for multiple febrile seizures in the same illness.

Keywords: Children; Complex febrile seizure; Febrile seizure; Infants; Meta-analysis; Systematic review.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Estimated baseline risk of multiple febrile seizures within the same illness for each cohort and a pooled estimate using a random effects model
Fig. 3
Fig. 3
Baseline risk of multiple febrile seizures within the same illness by setting: the points represent the percent risk of repeat febrile seizures by cohort, and the color represents the grouping variable. The dashed line represents the pooled estimate for that group, and the solid lines represent the 95% confidence intervals
Fig. 4
Fig. 4
Baseline risk of multiple febrile seizures within the same illness by studies with complete characteristics of febrile seizure: the points represent the percent risk of repeat febrile seizures by cohort, and the color represents the grouping variable. The dashed line represents the pooled estimate for that group, and the solid lines represent the 95% confidence intervals
See this image and copyright information in PMC

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