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Development of a prediction nomogram model of recurrent febrile seizures in pediatric children

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Abstract

The purpose of this study is to develop a prediction nomogram of recurrent febrile seizures in pediatric children based on the identified predictors for develo** recurrent febrile seizures. This is a retrospective observational study. The medical records of 320 febrile seizure-afflicted children admitted to Zhoushan Women and Children Hospital from March 2019 to January 2023 were retrospectively reviewed. Children were divided into the recurrent febrile seizures group and the non-recurrent febrile seizures group. The predictors of recurrent febrile seizures were identified by univariate and multivariate analyses. A prediction nomogram model was developed via R software. The performance of the nomogram was internally validated to assess the model’s discrimination and consistency, and decision curve analysis was employed to assess clinical utility. There were 41 out of 320 cases that had recurrent febrile seizures during the observation period, with a 12.81% prevalence rate of recurrent febrile seizures. The predictors of recurrent febrile seizures were young age at the first febrile seizures, a family history of febrile seizures in a first-degree relative, diurnal variation of initial febrile seizures occurrence, gender, and a low level of C-reactive protein. The area under the receiver operating characteristic curve of the nomogram is 0.795 (95% confidence interval: 0.720–0.871). Calibration plots and the result of the Hosmer–Lemeshow test (P = 0.472) reveal satisfactory consistency. Decision curve analysis showed a significant net benefit of the nomogram.

Conclusions: The prediction nomogram model demonstrates good performance and clinical utility, which would be a convenient tool for the detection of children in pediatrics with high-risk recurrent febrile seizures. It is useful for pediatric medical staff to provide early medical interventions and family counseling.

What is Known:

• A proportion of children experience recurrences of febrile seizures.

• Recognition of risk factors for recurrent FS in pediatrics would be useful for the prediction of risk probabilities and help provide tailored counseling and follow-up.

What is New:

• A nomogram model is developed for risk prediction of recurrent febrile seizures in this study, which would be a convenient risk prediction tool in pediatrics.

• The predictor of diurnal variation of recurrent febrile seizures is with new ideas.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

CRP :

C-reactive protein

CFS :

Complex febrile seizure

CT:

Computerized tomography

DCA:

Decision curve analysis

EEG :

Electroencephalography

FS:

Febrile seizure

Hb:

Hemoglobin

IQR :

Interquartile range

MRI:

Magnetic resonance imaging

OR :

Odds ratios

ROC:

Receiver operating characteristic

SFS :

Simple febrile seizure

VIF:

Variance inflation factor

WBC :

White blood cell

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Acknowledgements

The authors appreciate all participants who took part in this study for their time and efforts. The authors would also like to express their gratitude to the managers of the pediatric department at Zhoushan Women and Children Hospital for their approval to conduct this research.

Funding

The Science and Technology Plan Projects of the Bureau of Science and Technology in Zhoushan City, Zhejiang Province, China (No. 2021C31060).

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Authors and Affiliations

  1. The Department of Pediatric Ward, Zhoushan Women and Children Hospital, No. 238 Renmin North Road, Dinghai District, Zhoushan, 316000, Zhejiang, China

    Lingling Shao & Youna Yu

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  1. Lingling Shao
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  2. Youna Yu
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Contributions

All the authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Lingling Shao and Youna Yu. The first draft of the manuscript was written by Lingling Shao and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Youna Yu.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Zhoushan Women and Children Hospital (No. 2023–011).

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The requirement to obtain informed consent was waived.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Shao, L., Yu, Y. Development of a prediction nomogram model of recurrent febrile seizures in pediatric children. Eur J Pediatr 182, 4875–4888 (2023). https://doi.org/10.1007/s00431-023-05133-7

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