Question 2: Should children who have a febrile seizure be screened for iron deficiency?

You are a senior house officer working in a busy district general hospital in the UK. A 2-year-old child presents following a generalised tonic-clonic seizure that lasted around 1 min. He had recently been unwell with a cough and runny nose and was febrile at the time of the seizure. He now appears well and is running around the ward. You diagnose a simple febrile seizure secondary to a viral upper respiratory tract infection and, as it his first episode, admit him for observation. The local hospital protocol on the management of febrile seizures states no investigations are required. However, your registrar asks you to check a full blood count (FBC) and haematinics as he has recently read febrile seizures may be associated with iron deficiency. You wonder whether there is any evidence to support this statement. In children in the UK (population), does having a febrile seizure (indicator) compared with never having had a febrile seizure (comparison) increase the risk of being diagnosed with iron deficiency (outcome)? ### Primary search MEDLINE (1946–April 2014) and EMBASE (1947–April, 2014) using the OVID interface were searched. Search terms were: [Febrile seizures AND iron deficiency]. There were 25 hits of which 17 studies were relevant. One study was excluded as it was a cross-sectional study with no control group.1 This means that 16 studies were included in the final analysis. The references of these papers were checked, along with the linked articles, and no further studies were found. A further search of the same databases with the terms [Febrile convulsions AND iron deficiency] and [Febrile fits AND iron deficiency] did not reveal any additional relevant studies. ### Secondary search A Cochrane Library and BESTBETS search in …