Management of Simple Febrile Seizures: Home Versus Hospital Observation

Abstract

Introduction: Simple febrile seizures (SFS) lasting <15 minutes without recurrence within 24 hours are common (2-5% of children). Prolonged hospitalization is routine in many settings despite guidelines recommending home observation. Methods: Systematic review of 7 cohort studies (n=1,894) comparing hospital admission versus discharge from emergency department (ED) after first SFS in children 6-60 months. Primary outcomes: seizure recurrence within 1 week, parental anxiety (validated scale), healthcare cost. Results: Seizure recurrence within 1 week was 2.3% (admitted) vs 2.0% (discharged) (RR 1.15, p=0.68). Parental anxiety was significantly higher in admitted group (mean difference +1.8 on 10-point scale, p=0.02). Cost per patient was 3,200(admitted)vs3,200(admitted)vs480 (discharged). No cases of bacterial meningitis were missed in discharged group. Discussion: Admission does not prevent seizure recurrence and increases parental distress. Proper education on fever management and seizure first aid is critical. Conclusion: Routine admission for first simple febrile seizure is unnecessary. Discharge with structured education is safe and preferred.