Variation in seizure prophylaxis in severe pediatric traumatic brain injury

Ostahowski, Paige J; Kannan, Nithya; Wainwright, Mark S.; Qiu, Qian; Mink, Richard; Groner, Jonathan I.; Bell, Michael J.; Giza, Christopher C.; Zatzick, Douglas; Ellenbogen, Richard G.; Boyle, Linda Ng; Mitchell, Pamela H.; Vavilala, Monica S.; Study, Outcomes

doi:10.3171/2016.4.peds1698

Cited by 16 publications

(8 citation statements)

References 27 publications

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“…7 Other research has identified levetiracetam, phenobarbital, and valproic acid for EPTS prophylaxis in addition to phenytoin and fosphenytoin. 19,20 In a 2016 publication evaluating the use of levetiracetam for EPTS prophylaxis, the authors reported 17% of patients having EPTS with levetiracetam, which was higher than reported EPTS with phenytoin. 21 However, since the studies in this review were often not specific about the agents used, the purpose of these antiseizure agents (i.e., reduction in ICP or antiseizure prophylaxis) is often unclear in this setting.…”

Section: Discussionmentioning

confidence: 96%

Hyperosmolar Therapy for Severe Traumatic Brain Injury in Pediatrics: A Review of the Literature

Fenn¹,

Sierra²

2019

The Journal of Pediatric Pharmacology and Therapeutics

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Traumatic brain injury remains a leading cause of morbidity and mortality in children. The use of hyperosmolar therapy to offset increased intracranial pressure (ICP) is described in pediatric guidelines, yet some controversy remains regarding which option to select. A search was conducted using the PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health, Academic Search Premier, PsycInfo, and Cochrane Library databases. Studies were included if they described the hyperosmolar therapy use, involved severe traumatic brain injury (TBI), and patient age was 0 to 18 years. A total of 331 studies published between 1987 and 2017 were retrieved; of these, 9 met the inclusion criteria. Included studies were evaluated for the type and concentration of hyperosmolar therapy, associated mortality outcomes, ICP and coronary perfusion pressure (CPP) measurements, concurrent medications, and reported serum sodium and serum osmolarity or osmolality values. Hypertonic saline was the most commonly reported hyperosmolar therapy. Mannitol was less studied, but collectively demonstrated a higher incidence of mortality than hypertonic saline. There were several studies that did not report monitoring outcomes associated with serum sodium and/or serum osmolarity, despite the use of hyperosmolar therapies. Inconsistencies were noted between the studies in the overall study design as well as reported monitoring parameters and length of stay. Hypertonic saline appears to be safe and efficacious at several concentrations for treatment of increased ICP associated with severe TBI in pediatric patients. The limited available data regarding the use of mannitol do not allow a strong conclusion to be made regarding its use.

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Section: Discussionmentioning

confidence: 96%

Hyperosmolar Therapy for Severe Traumatic Brain Injury in Pediatrics: A Review of the Literature

Fenn¹,

Sierra²

2019

The Journal of Pediatric Pharmacology and Therapeutics

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“…Considering the high incidence of seizure in infantile TBI, an aggressive approach is needed to prevent early seizure in TBI in infants. Role of antiepileptic drug (AED) in pediatric PTE is not definitely determined 5 , 23) . However, many authors report the effectiveness of AED to prevent early seizure 11 , 19 , 21) .…”

Section: Discussionmentioning

confidence: 99%

Traumatic Brain Injury in Children under Age 24 Months : Analysis of Demographic Data, Risk Factors, and Outcomes of Post-traumatic Seizure

Yoon

Choi

Park

et al. 2017

J Korean Neurosurg Soc

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ObjectiveTraumatic brain injury (TBI) in children under age 24 months has characteristic features because the brain at this age is rapidly growing and sutures are opened. Moreover, children this age are completely dependent on their parents. We analyzed the demographic data and risk factors for outcomes in TBI patients in this age group to elucidate their clinical characteristics.MethodsWe retrospectively reviewed the medical records and radiological films of children under 24 months who were admitted to Kyungpook National University Hospital from January 2004 to December 2013 for TBI. Specifically, we analyzed age, cause of injury, initial Glasgow coma scale (GCS) score, radiological diagnosis, seizure, hydrocephalus, subdural hygroma, and Glasgow outcome scale (GOS) score, and we divided outcomes into good (GOS 4–5) or poor (GOS 1–3). We identified the risk factors for post-traumatic seizure (PTS) and outcomes using univariate and multivariate analyses.ResultsThe total number of patients was 60, 39 males and 21 females. Most common age group was between 0 to 5 months, and the median age was 6 months. Falls were the most common cause of injury (n=29, 48.3%); among them, 15 were falls from household furniture such as beds and chairs. Ten patients (16.7%) developed PTS, nine in one week; thirty-seven patients (61.7%) had skull fractures. Forty-eight patients had initial GCS scores of 13–15, 8 had scores of 12–8, and 4 had scored 3–7. The diagnoses were as follows: 26 acute subdural hematomas, 8 acute epidural hematomas, 7 focal contusional hemorrhages, 13 subdural hygromas, and 4 traumatic intracerebral hematomas larger than 2 cm in diameter. Among them, two patients underwent craniotomy for hematoma removal. Four patients were victims of child abuse, and all of them had PTS. Fifty-five patients improved to good-to-moderate disability. Child abuse, acute subdural hematoma, and subdural hygroma were risk factors for PTS in univariate analyses. Multivariate analysis found that the salient risk factor for a poor outcome was initial GCS on admission.ConclusionThe most common cause of traumatic head injury in individuals aged less than 24 months was falls, especially from household furniture. Child abuse, moderate to severe TBI, acute subdural hematoma, and subdural hygroma were risk factors for PTS. Most of the patients recovered with good outcomes, and the risk factor for a poor outcome was initial mental status.

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“…(6) Another recently published retrospective study of data from five centers reported an even higher rate of seizure prophylaxis, 79%. (9) Many (61.8%) of the children who received AEDs in our study received them on day 0 of the hospitalization, likely indicating prophylactic use. Similar to EEG monitoring, children with known risk factors for PTS were particularly likely to receive AEDs, as both child abuse and SDH were associated with AED use earlier in the hospitalization.…”

Section: Discussionmentioning

confidence: 76%

“…A recent retrospective analysis of children with severe TBI at five regional pediatric trauma centers concluded that 79% received seizure prophylaxis with AEDs, 63% of those within 24 hours of injury. (9) In a survey of 43 sites participating in a large observational cohort study, 90% of sites reported seizure prophylaxis with AEDs in children with severe TBI. (10) The same survey also reported wide center variation in approach to EEG monitoring.…”

Section: Introductionmentioning

confidence: 99%

EEG Monitoring and Antiepileptic Drugs in Children with Severe TBI

et al. 2016

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Introduction Traumatic brain injury (TBI) causes substantial morbidity and mortality in U.S. children. Post-traumatic seizures (PTS) occur in 11-42% of children with severe TBI and are associated with unfavorable outcome. Electroencephalographic (EEG) monitoring may be used to detect PTS and anti-epileptic drugs (AEDs) may be used to treat PTS, but national rates of EEG and AED use are not known. The purpose of this study was to describe the frequency and timing of EEG and AED use in children hospitalized after severe TBI. Methods Retrospective cohort study of 2,165 children at 30 hospitals in a probabilistically linked dataset from the National Trauma Data Bank (NTDB) and the Pediatric Health Information Systems (PHIS) database, 2007-2010. We included 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. The primary outcomes were EEG and AED use. Results Overall, 31.8% of the cohort had EEG monitoring. Of those, 21.8% were monitored on the first hospital day. The median duration of EEG monitoring was 2.0 (IQR: 1.0, 4.0) days. AEDs were prescribed to 52.0% of the cohort, of whom 61.8% received an AED on the first hospital day. The median duration of AED use was 8.0 (IQR: 4.0, 17.0) days. EEG monitoring and AED use were more frequent in children with known risk factors for PTS. EEG monitoring and AED use were not related to hospital TBI volume. Conclusion EEG use is relatively uncommon in children with severe TBI, but AEDs are frequently prescribed. EEG monitoring and AED use are more common in children with known risk factors for PTS.

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Variation in seizure prophylaxis in severe pediatric traumatic brain injury

Cited by 16 publications

References 27 publications

Hyperosmolar Therapy for Severe Traumatic Brain Injury in Pediatrics: A Review of the Literature

Hyperosmolar Therapy for Severe Traumatic Brain Injury in Pediatrics: A Review of the Literature

Traumatic Brain Injury in Children under Age 24 Months : Analysis of Demographic Data, Risk Factors, and Outcomes of Post-traumatic Seizure

EEG Monitoring and Antiepileptic Drugs in Children with Severe TBI

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