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Early post-traumatic seizures in children with head injury
A Chiaretti1, R De Benedictis, G Polidori
1Pediatric Intensive Care Unit, Catholic University of Rome, Italy. raffdebe@tin.it
Insights
Early post-traumatic seizures (PTS) in children are linked to severe head injuries, younger age, and cerebral edema. These seizures worsen outcomes, highlighting the need for prompt anti-epileptic drug prophylaxis in head-trauma patients.
Area of Science:
- Pediatric Neurology
- Neurotraumatology
- Clinical Epidemiology
Background:
- Post-traumatic seizures (PTS) are a significant complication following head injury in children.
- Early PTS can exacerbate secondary brain damage through various pathophysiological mechanisms.
- Identifying risk factors for early PTS is crucial for timely intervention.
Purpose of the Study:
- To conduct an epidemiological analysis of early PTS in children hospitalized for head injury.
- To identify potential risk factors associated with the onset of early PTS in pediatric patients.
- To evaluate the impact of early PTS on the outcome of head-injured children.
Main Methods:
- Retrospective study analyzing data from a Pediatric Intensive Care Unit.
- Assessment of injury severity using the Glasgow Coma Scale (GCS).
- Evaluation of patient outcomes using the Glasgow Outcome Score (GOS).
Main Results:
- Early PTS occurred in 12% of hospitalized children, with 73.3% developing seizures within 24 hours.
- Severe injury (GCS ≤ 8) was a major risk factor, increasing PTS incidence tenfold compared to mild injury (GCS 13-15).
- Younger age (< 3 years) and severe cerebral edema were also significant risk factors for early PTS.
Conclusions:
- Early PTS are associated with worse outcomes in head-injured children, particularly those with severe injuries.
- Children with early PTS had significantly higher rates of poor outcomes (GOS ≤ 3).
- Immediate prophylaxis with anti-epileptic drugs should be considered for head-trauma patients to mitigate secondary brain damage.
Abstract:
Post-traumatic seizures (PTS) can be a serious complication of head injury, because they can cause secondary brain damage through increased metabolic requirements, raised intracranial pressure, cerebral hypoxia, and/or excessive release of neurotransmitters. In children, early PTS are more frequent than late ones. In this retrospective study we conducted an epidemiological analysis and tried to identify potential risk factors for the onset of early PTS in children hospitalized for head injury in our Paediatric Intensive Care Unit. The severity of injury was assessed using the Glasgow Coma Scale (GCS), while the outcome of traumatized children was defined using the Glasgow Outcome Score (GOS). Early PTS were diagnosed in 15 out of the 125 children hospitalized (12%). Most of the children (73.3%), developed seizures within 24 h of the trauma (immediate PTS). Among the risk factors, a very important role was played by the severity of the injury; in fact, the incidence of early PTS among patients with GCS < or = 8 was ten times greater than that among children with GCS 13-15. Other risk factors that significantly influenced the onset of early PTS, were age (60% of children with early PTS were less than 3 years old) and severe cerebral edema. Overall, children with early PTS had a worse outcome than the other patients. In fact, 53% had a GOS of < or = 3 compared to 19.1% of those without early PTS (P<001). In particular, considering children with severe head injury, 80% of those with early PTS had a GOS of < or = 3, compared to 41% of those without early PTS (P<0.05). In conclusion, PTS can be a serious complication of head injury in children, because they can worsen secondary brain damage. Appropriate management of head-trauma patients must include suitable and immediate prophylaxis with anti-epileptic drugs.