Early Posttraumatic Seizures in the Pediatric Population

Arndt, Daniel H.; Goodkin, Howard P.; Giza, Christopher C.

doi:10.1177/0883073814562249

Cited by 21 publications

(29 citation statements)

References 93 publications

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“…(3, 4) In our study, these factors were at the discretion of the treatment team. EEG monitoring was utilized for only 61.4% of children with PTS and 22.5% of those without PTS.…”

Section: Discussionmentioning

confidence: 99%

“…Specific skull and cerebral imaging findings, such as depressed skull fracture, intraparenchymal hemorrhage, and cerebral edema, have been associated with PTS after pediatric TBI. (4, 16) Unfortunately, our dataset does not allow assessment of these specific imaging findings.…”

Section: Discussionmentioning

confidence: 99%

“…Post-traumatic seizures (PTS) are one factor that may contribute to secondary cerebral injury. PTS are typically classified based on time of occurrence (3, 4): impact seizures occur within minutes after injury, early PTS within 7 days, and late PTS after 7 days. Other than impact seizures, all PTS have been consistently associated with poorer outcomes after TBI (3, 5–8).…”

Section: Introductionmentioning

confidence: 99%

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Seizures in Children With Severe Traumatic Brain Injury*

Bennett

DeWitt

Harlaar

et al. 2017

Pediatric Critical Care Medicine

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Objective Traumatic brain injury (TBI) causes substantial morbidity and mortality in children. Post-traumatic seizures (PTS) may worsen outcomes after TBI. PTS risk factors are incompletely understood. Our objective was to clarify PTS risk factors in a large cohort of children with severe TBI. Design Retrospective cohort study of a probabilistically linked dataset from the National Trauma Data Bank (NTDB) and the Pediatric Health Information Systems (PHIS) database, 2007–2010 Setting 29 U.S. children’s hospitals Patients 2,122 children (age < 18 years old at admission) with linked NTDB and PHIS records, severe (Emergency Department [ED] Glasgow Coma Scale [GCS] < 8) TBI, hospital length of stay > 24 hours, and non-missing disposition Interventions None Measurements and Main Results The outcome was PTS, identified using validated ICD-9-CM diagnosis codes. Pre-specified candidate predictors of PTS included age, injury mechanism, ED GCS, intracranial hemorrhage type, hypoxia, hypotension, and cardiac arrest. PTS were diagnosed in 25.2% of children with severe TBI. In those without abuse/assault or subdural hemorrhage (SDH), the PTS rate varied between 36.6% in those < 2 years old and 16.4% in those 14–17 years old. Age, abusive mechanism, and subdural hemorrhage (SDH) are each significant predictors of PTS. The risk of PTS has a complex relationship with these predictors. The estimated odds of PTS decrease with advancing age, OR = 0.929 (0.905, 0.954) per additional year of age with no abuse/assault and no SDH; OR = 0.820 (0.730, 0.922) per additional year of age when abuse and SDH are present. An infant with accidental TBI and SDH has approximately the same estimated probability of PTS as an abused infant without SDH, 47% (95% CI: 39%, 55%) versus 50% (95% CI: 41%, 58%), P = 0.69. The triad of young age, injury by abuse/assault, and SDH confers the greatest estimated probability for PTS, 60% (95% CI: 53%, 66%). Conclusions PTS risk in children with severe TBI is greatest with a triad of younger age, injury by abuse/assault, and SDH. However, PTS is common even in the absence of these factors.

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“…(3, 4) In our study, these factors were at the discretion of the treatment team. EEG monitoring was utilized for only 61.4% of children with PTS and 22.5% of those without PTS.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Seizures in Children With Severe Traumatic Brain Injury*

Bennett

DeWitt

Harlaar

et al. 2017

Pediatric Critical Care Medicine

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“…Studies examining early PTS in pediatric TBI report increased mortality rates and worse neurodevelopmental outcomes. 16–18 Early PTS has been reported in up to 42.5% of pediatric TBI with possible mechanisms associated with increased intracranial pressure and increased cerebral metabolism. 19 However, diagnosis of PTS is challenging in a patient who does not exhibit symptoms of clinical seizures.…”

Section: Introductionmentioning

confidence: 99%

Continuous electroencephalography in pediatric traumatic brain injury: Seizure characteristics and outcomes

Vaewpanich

Reuter‐Rice

2016

Epilepsy & Behavior

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Background Traumatic injury (TBI) is a major cause of pediatric morbidity and mortality. Secondary injury that occurs as a result of a direct impact plays a crucial role in patient prognosis. The guidelines for the management of severe TBI target treatment of secondary injury. Posttraumatic seizure, one of the secondary injury sequelae, contributes to further damage to the injured brain. Continuous electroencephalography (cEEG) helps detect both clinical and subclinical seizure, which aids early detection and prompt treatment. Objective To examine the relationship between cEEG findings in pediatric traumatic brain injury and neurocognitive/functional outcomes. Methods This study focuses on a subgroup of a larger prospective parent study that examined children admitted to a level-1 trauma hospital. The subgroup included sixteen children admitted to the pediatric intensive care unit (PICU) who received cEEG monitoring. Characteristics included demographics, cEEG reports, antiseizure medication. We also examined outcome scores at time of discharge and 4–6 weeks post-discharge using the Glasgow Outcome Scale-Extended Pediatrics and a center-based speech pathology neurocognitive/functional evaluation scores. Results Sixteen patients were included in this study. Patients with severe TBI made up the majority of those that received cEEG monitoring. Non-accidental trauma was the most frequent TBI etiology (75%) and subdural hematoma was the most common lesion diagnosed by CT scan (75%). Fifteen patients received anti-seizure medication and levetiracetam was the medication of choice. Four patients (25%) developed seizures during PICU admission and 3 patients had subclinical seizures that were detected by cEEG. One of these patients also had both a clinical and subclinical seizure. Non-accidental trauma was an etiology of TBI in all seizure patients. Characteristics of a non-reactive pattern, severe/burst suppression and lack of sleep architecture, on cEEG were associated with poor neurocognitive/functional outcome. Conclusion Continuous electroencephalography demonstrated a pattern that associated seizures and poor outcomes in patients with moderate to severe traumatic brain injury, particularly in a subgroup of non-accidental trauma patients. Best practice should include institutional based TBI cEEG protocols, which may detect early of seizure activity and promote outcomes. Future studies should include examination of individual cEEG characteristics to help improve outcomes in pediatric TBI.

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“…It is likely that these two phases involve different pathophysiologic mechanisms. Early PTS may be associated with acute neurologic decline and worse functional outcomes (4); however, current evidence to guide the clinical management of early PTS in children is limited. Recent evidence-based guidelines for the medical management of TBI in children contain no level I or level II recommendations for the management of early PTS (5), and there are insufficient data to guide anti-seizure drug selection.…”

Section: Introductionmentioning

confidence: 99%

Variation in Anticonvulsant Selection and Electroencephalographic Monitoring Following Severe Traumatic Brain Injury in Children—Understanding Resource Availability in Sites Participating in a Comparative Effectiveness Study

Kurz

Poloyac

Abend

et al. 2016

Pediatric Critical Care Medicine

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Objective Early post-traumatic seizures (PTS) may contribute to worsened outcomes after traumatic brain injury (TBI). Evidence to guide the evaluation and management of early PTS in children is limited. We undertook a survey of current practices of continuous electroencephalographic monitoring (cEEG), seizure prophylaxis and the management of early PTS to provide essential information for trial design and the development of PTS management pathways. Design Surveys were sent to site principal investigators at all 43 sites participating in the ADAPT (Approaches and Decisions in Acute Pediatric TBI) trial at the time of the survey. Surveys consisted of 12 questions addressing strategies to (i) implement cEEG monitoring, (ii) PTS prophylaxis, (iii) treat acute PTS, (iv) treat status epilepticus (SE) and refractory status epilepticus (RSE) and (v) monitor anti-seizure drug levels. Setting Institutions comprised a mixture of free-standing children’s hospitals and university medical centers across the United States and Europe. Measurements and Main Results cEEG monitoring was available in the pediatric intensive care unit in the overwhelming majority of clinical sites (98%); however, the plans to operationalize such monitoring for children varied considerably. A similar majority of sites report that administration of prophylactic anti-seizure medications is anticipated in children (93%), yet a minority reports that a specified protocol for treatment of PTS is in place (43%). Reported medication choices varied substantially between sites, but the majority of sites reported pentobarbital for RSE (81%). Presence of an treatment protocols for seizure prophylaxis, early PTS, post-traumatic SE and RSE was associated with decreased reported medications (all p < 0.05). Conclusions This study reports the current management practices for early PTS in select academic centers after pediatric severe TBI. The substantial variation in cEEG implementation, choice of seizure prophylaxis medications, and management of early PTS across institutions was reported, signifying areas of clinical uncertainty that will help provide for focused design of clinical trials. While sites with treatment protocols reported decreased number of medications for the scenarios described, completion of the ADAPT Trial will be able to determine if these protocols lead to decreased variability in medication administration in children at the clinical sites.

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Early Posttraumatic Seizures in the Pediatric Population

Cited by 21 publications

References 93 publications

Seizures in Children With Severe Traumatic Brain Injury*

Seizures in Children With Severe Traumatic Brain Injury*

Continuous electroencephalography in pediatric traumatic brain injury: Seizure characteristics and outcomes

Variation in Anticonvulsant Selection and Electroencephalographic Monitoring Following Severe Traumatic Brain Injury in Children—Understanding Resource Availability in Sites Participating in a Comparative Effectiveness Study

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