(840) Epidemiology and Trends of Hospitalization With Febrile Seizures in Children in the United States

Introduction: Febrile seizures (FS) are the most common type of seizure in children under 6 years of age. In 2011, the AAP published guidelines for investigating FS. However, there is a paucity of published data on the hospitalization rates and resource utilization for FS in the US. This study aims to describe the epidemiology, trend, and resource utilization of hospitalized children with FS in the US from 2006 to 2019.

Methods: A retrospective serial cross-sectional analysis of the Kids' Inpatient Database (2006, 2009, 2012, 2016, and 2019) was performed. ICD 9 and 10 codes were used to identify simple and complex FS. Children aged 0-6 years were included and neonates were excluded. Demographic data were compared between FS and other discharges. Diagnostic procedures (lumbar puncture (LP), neuroimaging (CT and MRI), and EEG) were compared between simple and complex FS, age group 0-2 and 3-6 years, and between 2006-2012 and 2016-2019. The Extended Mantel-Haenszel, chi-square, and Mann-Whitney U tests were used for inferential statistics.

Results: Of 6.75 million discharges, 63,856 children had FS (9.5 per 1000 discharges). The prevalence of hospitalization due to FS was 45.6 per 100,000 US population of 0-6 years of age and decreased from 58.3 in 2006 to 32.2 in 2019 (p < 0.001). Simple FS was present in 71.2% of FS discharges. The peak age of presentation was 1 year, with 80% of cases under 3 years of age, 36.4% came from the lowest income quartile, and 17.1% came from the highest income quartile. Most discharges were in winter (30.6%; p< 0.05). A bacterial infection was documented in 7.4%, and a viral infection in 12.9%. One of the diagnostic procedures was done in 28.7%, and 5.1% required mechanical ventilation. Diagnostic procedures were performed more often in complex FS and younger children (p < 0.001). The use rate of LP and neuroimaging decreased, and EEG increased during 2016-2019 (p < 0.001). Median length of hospital stay was 2 (IQR: 1-3) days, and median hospital charges (inflation-adjusted to 2019) were $10,945 (6,550-18,889).

Conclusions: The rate of hospitalization due to FS decreased from 2006 to 2019. Following AAP guidelines, the rate of use of LP and neuroimaging decreased, and EEG increased in hospitalized children with FS. The study's findings have implications for policy implementation.