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Published on: June 21, 2019
Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following
Anne C Ritter1,2, Amy K Wagner2,3,4,5, Jerzy P Szaflarski6
1Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Insights
New models predict posttraumatic seizures (PTS) after traumatic brain injury (TBI). While acute care predictions were poor, models for year 1 and year 2 showed fair to good validity for identifying individuals at risk for PTS.
Area of Science:
- Neurology
- Neurosurgery
- Trauma Care
Background:
- Posttraumatic seizures (PTS) are common complications following traumatic brain injury (TBI).
- Existing prognostic models for PTS lack widespread clinical adoption and do not reflect current medical practices.
- Significant variability exists in predicting which individuals will develop PTS after TBI.
Purpose of the Study:
- To develop and internally validate prognostic regression models for predicting PTS.
- To predict PTS risk during acute care hospitalization, and at 1 and 2 years post-TBI.
Main Methods:
- Utilized a 2011-2014 cohort from the TBI Model Systems National Database.
- Employed bivariable and multivariable logistic regression with backward-stepwise elimination.
- Internal validation was performed using 1,000 bootstrap samples with corrections for overfitting.
Main Results:
- Models identified sex, craniotomy, contusion load, and pre-injury cognitive limitations as predictors during acute hospitalization.
- Year 1 and Year 2 models identified predictors including subdural hematoma, contusion load, cranial surgery, acute seizures, posttraumatic amnesia duration, and pre-injury factors.
- Corrected concordance statistics were 0.599 (acute), 0.747 (Year 1), and 0.716 (Year 2).
Conclusions:
- The prognostic model for acute hospitalization showed limited predictive ability.
- Models for Year 1 and Year 2 demonstrated fair to good predictive validity for PTS.
- Further research is needed to validate these models externally and assess their clinical utility, particularly concerning cranial surgery implications.
Objective:
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 (2011-2014) 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 pre-injury 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 were similar to those of year 1: SDH, intraparenchymal fragment, craniotomy, craniectomy, seizure during acute hospitalization, and preinjury incarceration. Corrected concordance (C) statistics were 0.599, 0.747, and 0.716 for acute hospitalization, year 1, and year 2 models, respectively.
Significance:
The prognostic model for PTS during acute hospitalization did not discriminate well. Year 1 and year 2 models showed fair to good predictive validity for PTS. Cranial surgery, although medically necessary, requires ongoing research regarding potential benefits of increased monitoring for signs of epileptogenesis, PTS prophylaxis, and/or rehabilitation/social support. Future studies should externally validate models and determine clinical utility.
