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Immediate posttraumatic seizures: is routine hospitalization necessary?
1Department of Neurosurgery, Children's Hospital of Buffalo, State University of New York at Buffalo, NY 14222, USA. mdias@chob.edu
Insights
Children with minor head injuries and simple posttraumatic seizures (PTS) may be safely discharged from the emergency room if they meet specific criteria. This approach could reduce hospital admissions for these patients.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Neurosurgery
Background:
- Pediatric neurosurgeons often admit children with posttraumatic seizures (PTS) for observation.
- An estimated 86% of pediatric neurosurgeons routinely admit these patients.
- This practice leads to unnecessary hospitalizations and costs.
Purpose of the Study:
- To determine if children with minor head injuries and simple PTS can be safely discharged from the emergency room.
- To identify criteria for safe discharge of pediatric patients with PTS.
- To reduce unnecessary hospital admissions and healthcare costs.
Main Methods:
- Retrospective review of 71 children admitted with seizure and head injury over 5 years.
- Inclusion criteria: minor head injury, PTS within 24 hours, normal admission CT scan.
- Exclusion criteria: prior neurological conditions, prior seizures, prior anticonvulsant use, intracranial abnormalities.
Main Results:
- Of 71 children, 11 required ICU admission due to prolonged seizures, apnea, or low GCS.
- The remaining 60 children with simple PTS had no further seizures or complications.
- Average hospital cost for non-ICU patients was $1,615.
Conclusions:
- Children with isolated minor head injuries and simple PTS, normal CT scans, and no prior neurological history are at low risk for recurrence.
- These patients may be safely discharged to a reliable caretaker.
- Larger studies are needed to confirm these findings and establish a standard policy.
Objective:
A recent Internet survey of pediatric neurosurgeons showed that 86% routinely admitted children with immediate posttraumatic seizures (PTS) for a brief period of observation. We wished to determine whether certain children meeting predefined criteria could instead be safely discharged from the emergency room.
Methods:
We reviewed the records of children admitted during the past 5 years with a diagnosis of seizure and head injury. Children with a minor head injury, a PTS occurring within 24 h of injury and no intracranial abnormalities on admission CT scan were included. Children with previous neurological conditions, a history of prior seizures (other than PTS or febrile seizures), a prior history of anticonvulsant use, or intracranial abnormalities on the admission CT scan were excluded. Records were abstracted for child's age, gender, length of admission, previous history of PTS or febrile seizures, mechanism of injury, location of impact, time between impact and PTS, the number, length and type of PTS, Glasgow Coma Score (GCS) on admission, subsequent complications and hospital costs.
Results:
Seventy-one children met the inclusion criteria. Eleven children presented to the emergency room with prolonged seizures, transient apnea or persistently low GCS and required admission to the intensive care unit (ICU). Among the 60 remaining children with simple PTS, none had further seizures during the follow-up period, and none had significant complications. The average cost of hospitalization was known for 58 children; after excluding the costs for 5 patients who were admitted to the ICU, the average hospital cost amounted to USD 1,615 per patient.
Conclusions:
Our data suggest that children with isolated minor head injuries and simple PTS who recover fully in the emergency room, whose CT scans show no intracranial abnormalities and who have no prior history of neurological disease, epilepsy or anticonvulsant use are at low risk for recurrent seizures or neurological complications, and could potentially be sent home to a reliable caretaker and a stable home situation. However, because of the limited sample size in this study, the statistical risk of a bad outcome may be as high as 9%; we therefore suggest that much larger studies are potentially needed before this becomes a standard policy.