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Childhood febrile convulsions - do treatment patterns determine the risk of early recurrence?

Project Member(s): Callander, E.

Funding or Partner Organisation: National Health & Medical Research Council (NHMRC- Clinical Trials and Cohort Studies Grants)
National Health & Medical Research Council (NHMRC- Clinical Trials and Cohort Studies Grants)

Start year: 2022

Summary: This is a proposal for a stepped wedge cluster randomised controlled trial comparing usual ED care to regularly administered antipyretics for children being discharged from the emergency department (ED) following a febrile convulsion across 25 Australia and New Zealand hospitals. Febrile convulsions (FC) are relatively common. Current guidelines do not recommend use of anticonvulsants nor antipyretics in ongoing management after an ED attendance. However, a recent single centre Japanese randomised controlled trial (RCT) comparing regular use of rectal paracetamol to no treatment found that seizure recurrence within the same febrile illness was 9.1% in the treatment group compared to 23.5% in the control group. While this study has resulted in considerable discussion, its effect on clinical practice remains unknown. Contributing factors to this include: (1) confusion exists between the evidence regarding prophylactic antipyretic use (no benefit in prevention of recurrence in a separate future febrile illness) and regular antipyretic use in the first 24 hours of an ongoing febrile illness after a convulsion (possible benefit); (2) lack of external validity of the single centre study from Japan; (3) FS rates and recurrence rates are possibly higher in the Japanese population compared to the paediatric population in Australia / NZ, and (4) rectal paracetamol is not routinely prescribed in Australia / NZ where oral paracetamol and/or oral ibuprofen predominate. We will enrol children planned for discharge home from the ED after a febrile convulsion. Patients attending "control" hospitals will have "treatment as usual". Patients attending "intervention" hospitals will be treated with advice to take regular antipyretics (paracetamol or ibuprofen) for the next 24 hours. Outcomes to be assessed include seizure recurrence in the same febrile illness (primary outcome), hospital reattendance, antipyretic use, healthcare and other costs; and quality of life.

FOR Codes: Health economics , Urgent and critical care, and emergency medicine