Short term outcome of seizures associated with fever in children in primary health care in Kinshasa

Background: The immediate prognosis of febrile convulsions is a subject of importance to both clinicians and families. Aim: Our study aims to analyse the factors that establish the clinical course in the first 24 hours in children admitted with febrile convulsion Methods: 148 children, aged between 5 and 71 months, were prospectively enrolled at their admission for febrile convulsions in two paediatric reference centres in Kinshasa between 10th February and 10th May, 2008. The clinical course over 24 hours was documented and analysed with regard to the clinical features of the initial crisis. Results: 80% of children were less than 3 years old. Based on the clinical presentations, 8 subgroups were distinguished. The 2 groups characterized by the absence (Group 1) or presence (Group 8) of the three identified prognostic factors had significantly different clinical courses over 24 hours (p<0.05). Group 8 contained children with the worst clinical course, characterised by seizure recurrence, neurological deficits and death. Focal type seizures, prolonged seizures and recurrent seizures were all associated with a worse outcome on univariate analysis, but on multivariate analysis, only recurrent seizures predicted a significantly worse prognosis (OR 4.4, CI 2.0-9.6). Conclusion Febrile convulsions present with different clinical characteristics and these have short term prognostic value. Regardless of the underlying cause, recognition of these poor prognostic factors should allow the establishment of appropriate surveillance and preventative treatment measures.