RISK FACTORS ASSOCIATED WITH FEBRILE SEIZURES AMONG CHILDREN PRESENTING TO THE EMERGENCY DEPARTMENT

Background: Febrile seizures are the most common seizure disorder in childhood and are a frequent cause of presentation to pediatric emergency departments. Although most febrile seizures are simple and have a favorable prognosis, complex febrile seizures may be associated with specific clinical, familial, developmental, and biochemical risk factors. Identification of these factors may help clinicians recognize children who require closer assessment and follow-up. Objectives: To assess the risk factors associated with febrile seizures among children presenting to the emergency department, with particular emphasis on factors associated with complex febrile seizures. Patients and methods: A hospital-based cross-sectional study was conducted at Al-Khansaa Teaching Hospital, Nineveh Governorate, Iraq, from March 2025 to July 2026. The study included 86 children presenting with febrile seizures. Data were collected regarding demographic characteristics, family and personal history, characteristics of the febrile illness, seizure characteristics, clinical findings, and selected laboratory parameters. The association between potential risk factors and seizure complexity was assessed using appropriate statistical tests and multivariable logistic regression analysis. A P-value <0.05 was considered statistically significant. Results: The mean age of the studied children was 2.6 ± 1.3 years, and males constituted 55.8% of the sample. Simple febrile seizures were predominant, occurring in 68 (79.1%) children, while 18 (20.9%) had complex febrile seizures. Respiratory tract infection was the most common source of fever, identified in 45 (52.3%) children. Complex febrile seizures were significantly associated with temperature ≥39°C (88.9% versus 63.2%, P=0.040), fever lasting >48 hours (38.9% versus 13.2%, P=0.012), family history of febrile seizures (50.0% versus 29.4%, P=0.041), family history of epilepsy (27.8% versus 10.3%, P=0.049), previous febrile seizures (50.0% versus 22.1%, P=0.021), and developmental delay (22.2% versus 4.4%, P=0.014). Mean serum calcium was significantly lower among children with complex seizures (2.19 ± 0.16 versus 2.27 ± 0.14 mmol/L, P=0.041). On multivariable analysis, temperature ≥39°C (adjusted OR=3.42), fever >48 hours (adjusted OR=3.76), family history of febrile seizures (adjusted OR=2.91), previous febrile seizure (adjusted OR=3.34), developmental delay (adjusted OR=4.62), and serum calcium <2.20 mmol/L (adjusted OR=2.87) were independently associated with complex febrile seizures. The combined predictors demonstrated an AUC of 0.812, with 77.8% sensitivity and 75.0% specificity. Conclusions: Febrile seizures in this cohort were predominantly simple and generalized. Higher fever, prolonged fever, family history of febrile seizures, previous febrile seizures, developmental delay, and lower serum calcium were associated with complex febrile seizures. A structured assessment incorporating clinical, familial, developmental, and selected laboratory factors may help identify children at greater risk of complex seizure presentation. Larger prospective multicenter studies are recommended to validate these findings in Iraqi children.