Incidence and prognostic factors for febrile seizure recurrence in children: A prospective cohort study in Vietnam

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Abstract
Background: Febrile seizures (FS) are a common neurological emergency in early childhood and frequently raise concerns among caregivers regarding the likelihood of recurrence. Accurate risk stratification is important for counseling and follow‐up, particularly in resource‐limited settings. We aimed to estimate the incidence and identify prognostic factors for FS recurrence, and to propose a simple approach for clinical risk stratification. Methods: In this prospective cohort study conducted at the Children's Hospital 2 (Ho Chi Minh City, Vietnam), we enrolled 631 children aged 1 month to 6 years with a first FS and followed them for recurrence over a median follow‐up of 1.9 years. A simple count‐based approach to risk stratification was derived from independent predictors identified by multivariable Cox regression. Results: During follow‐up, 174 children (27.6%) experienced recurrence, corresponding to an incidence of 173 per 1000 person‐years. The predictors included: age < 21 months at first FS (adjusted HR: 2.02; 95% CI: 1.45, 2.81), family history of FS (adjusted HR: 1.83; 95% CI: 1.34, 2.49), and multiple seizures within the same febrile illness (adjusted HR: 1.60; 95% CI: 1.17, 2.21). Two‐year recurrence risk ranged from 13.8% (0 predictors) to 63.1% (3 predictors). Model discrimination was modest, with a bootstrap‐corrected AUC of 0.67 (95% CI: 0.62–0.72). Conclusions: Our findings provide contemporary data on the incidence and risk factors of FS recurrence and support a simple, clinically applicable approach to risk stratification. This information may assist clinicians in counseling families and planning follow‐up, particularly in resource‐limited settings.

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