Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following traumatic brain injury

Abstract

SUMMARYObjective: Posttraumatic seizures (PTS) are well-recognized acute and chronic complications of traumatic brain injury (TBI). Risk factors have been identified, but considerable variability in who develops PTS remains. Existing PTS prognostic models are not widely adopted for clinical use and do not reflect current trends in injury, diagnosis, or care. We aimed to develop and internally validate preliminary prognostic regression models to predict PTS during acute care hospitalization, and at year 1 and year 2 postinjury. Methods: Prognostic models predicting PTS during acute care hospitalization and year 1 and year 2 post-injury were developed using a recent (2011)(2012)(2013)(2014) cohort from the TBI Model Systems National Database. Potential PTS predictors were selected based on previous literature and biologic plausibility. Bivariable logistic regression identified variables with a p-value < 0.20 that were used to fit initial prognostic models. Multivariable logistic regression modeling with backward-stepwise elimination was used to determine reduced prognostic models and to internally validate using 1,000 bootstrap samples. Fit statistics were calculated, correcting for overfitting (optimism). Results: The prognostic models identified sex, craniotomy, contusion load, and preinjury limitation in learning/remembering/concentrating as significant PTS predictors during acute hospitalization. Significant predictors of PTS at year 1 were subdural hematoma (SDH), contusion load, craniotomy, craniectomy, seizure during acute hospitalization, duration of posttraumatic amnesia, preinjury mental health treatment/ psychiatric hospitalization, and preinjury incarceration. Year 2 significant predictors

Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study

“…In the current population, pTBI prevalence was significantly greater in nonwhites compared to those self‐identified as white. However, previous work developing prognostic models for PTS using a more recent cohort from the TBIMS‐NDB did not find race to be associated with PTS and did not investigate race as a PTS predictor in multivariable modeling . Differences in late PTS risk by race may also potentially reflect genetic differences thought to influence PTS risk .…”

“…The lack of significantly greater RRs for men could be confounded by survival bias if men were more severely injured and did not survive to year 5. However, in a more recently injured TBIMS‐NDB cohort, men were at higher risk for seizures during acute care hospitalization, even in multivariable models including markers of injury severity . Although injury severity is a factor reported in other epidemiologic studies describing PTS, our population included only individuals with moderate‐to‐severe TBI surviving their injury and qualifying for inpatient rehabilitation, a patient selection bias that may limit the sensitivity of this variable to PTS risk.…”

“…However, previous work developing prognostic models for PTS using a more recent cohort from the TBIMS-NDB did not find race to be associated with PTS and did not investigate race as a PTS predictor in multivariable modeling. 31 Differences in late PTS risk by race may also potentially reflect genetic differences thought to influence PTS risk. [34][35][36][37] Future work might investigate racial/ethnic differences in epilepsyrelated outcomes and comorbidity burden.…”

Posttraumatic seizures: a prospective cohort study

“…По данным литературы [13][14][15][16][17][18][19][20][21][22][23], заболеваемость ранними и поздними ПТП составляет от 2 до 19% и при определенных условиях может достигать 30% и более. Доля пациентов с ранними (18,1%) и поздними (6,3%) приступами у обследуемых пациентов в настоящем исследовании находилась в пределах указанных диапазонов.…”

“…В ранее проведенных исследованиях [12][13][14][15][16][17][18][19][20][21][22][23] были установлены факторы, влияющие на частоту возникновения ПТП. Однако в них нередко наблюдаются значительные расхождения.…”