SHM Converge Scientific Abstract ePoster Gallery-Variation and Establishment of Achievable Benchmarks of Care in Neurodiagnostic Testing Among Children Evaluated for Simple Febrile Seizures

Variation and Establishment of Achievable Benchmarks of Care in Neurodiagnostic Testing Among Children Evaluated for Simple Febrile Seizures

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This cross-sectional study examined 51,015 emergency department encounters for children aged 6 months to 5 years with simple febrile seizures across 38 children’s hospitals in the Pediatric Health Information System from 2016–2019. Children with epilepsy, complex febrile seizures, complex chronic conditions, or ICU care were excluded.<br /><br />The study aimed to describe variation in neurodiagnostic testing and hospitalization, and to establish Achievable Benchmarks of Care (ABCs) for these outcomes. Outcomes included neuroimaging, EEG, lumbar puncture (LP), hospitalization, and costs. ABCs were defined using the best-performing hospitals that together cared for 10% of the study cohort.<br /><br />Overall use of neurodiagnostic testing was low, consistent with guidelines discouraging routine testing in simple febrile seizures:<br />- Neuroimaging: 821 encounters (1.6%)<br />- EEG: 554 (1.1%)<br />- LP: 314 (0.6%)<br />- Hospitalization: 2,023 (4.0%)<br /><br />Despite low overall use, there was substantial variation across hospitals:<br />- Neuroimaging ranged from 0% to 4.6%<br />- EEG from 0% to 8.2%<br />- LP from 0% to 12.7%<br />- Hospitalization from 0% to 14%<br /><br />Testing was much more common in hospitalized patients than in ED-only encounters:<br />- Neuroimaging: 15.3% vs 1.0%<br />- EEG: 24.7% vs 0.1%<br /><br />Calculated ABCs were approximately 1% for all metrics, showing that top-performing hospitals achieved very low rates of testing and admission. The findings suggest that although care is generally aligned with guidelines, meaningful institutional variation remains. ABCs may help hospitals set realistic improvement targets, especially to reduce unnecessary hospitalization and further standardize care.

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Author List John R. Stephens, Matt Hall, Matthew J. Molloy, Jessica L. Markham, Jillian M. Cotter, Micke J. Tchou, Paul L. Aronson, Michael J. Steiner, Elisha McCoy, Meghan E. Collins, Samir S. Shah

Category Research

Concept Simple Febrile Seizure

Concept Neurodiagnostic Testing

Concept Hospitalization

Concept Institutional Variation

Concept Neuroimaging

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author John R. Stephens

Track Pediatric

Keywords

simple febrile seizures

pediatric emergency department

neurodiagnostic testing

hospitalization

neuroimaging

electroencephalography

lumbar puncture

practice variation

achievable benchmarks of care

children's hospitals

Simple Febrile Seizure

Neurodiagnostic Testing

Hospitalization

Institutional Variation

Neuroimaging