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Seizures in Children With Severe Traumatic Brain Injury
Kimberly Statler Bennett1, Peter E DeWitt, Nicole Harlaar
11Section of Pediatric Critical Care, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.2Department of Bioinformatics and Biostatistics, University of Colorado Denver, Aurora, CO.3Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.4Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO.
Insights
Young children with severe traumatic brain injury face higher risks of posttraumatic seizures, especially when abuse and subdural hemorrhage are present. These seizures are common even without these specific risk factors.
Area of Science:
- Pediatric neurology
- Neurotrauma
- Epidemiology
Background:
- Traumatic brain injury (TBI) is a significant cause of death and disability in children.
- Posttraumatic seizures (PTS) can exacerbate outcomes following TBI, but their risk factors remain unclear.
- Understanding PTS predictors is crucial for improving pediatric TBI management.
Purpose of the Study:
- To identify and clarify risk factors for PTS in a large cohort of pediatric patients with severe TBI.
- To analyze the relationship between age, injury mechanism, and intracranial hemorrhage and PTS occurrence.
- To quantify the probability of PTS based on combinations of these risk factors.
Main Methods:
- Retrospective cohort study utilizing linked data from the National Trauma Data Bank and Pediatric Health Information Systems (2007-2010).
- Inclusion criteria: 2,122 children (<18 years) with severe TBI (Glasgow Coma Scale < 8), prolonged hospital stay (>24 hours).
- PTS identified via ICD-9-CM codes; predictors analyzed included age, injury mechanism (abuse/assault), and subdural hemorrhage.
Main Results:
- PTS occurred in 25.2% of children with severe TBI.
- Younger age (<2 years) was associated with higher PTS rates (36.6%) compared to older children (14-17 years, 16.4%) in the absence of abuse or subdural hemorrhage.
- Age, abusive injury mechanism, and subdural hemorrhage were significant PTS predictors.
- The combination of young age, abuse, and subdural hemorrhage conferred the highest estimated PTS probability (60%).
Conclusions:
- The highest risk for PTS in pediatric severe TBI is associated with the triad of young age, abusive injury, and subdural hemorrhage.
- PTS remain a common complication even when these specific risk factors are absent.
- Further research into the complex interplay of these factors is warranted for targeted interventions.
Objective:
Traumatic brain injury causes substantial morbidity and mortality in children. Posttraumatic seizures may worsen outcomes after traumatic brain injury. Posttraumatic seizures risk factors are not completely understood. Our objective was to clarify posttraumatic seizures risk factors in a large cohort of children with severe traumatic brain injury.
Design:
Retrospective cohort study of a probabilistically linked dataset from the National Trauma Data Bank and the Pediatric Health Information Systems database, 2007-2010.
Setting:
Twenty-nine U.S. children's hospitals.
Patients:
A total of 2,122 children (age, < 18 yr old at admission) with linked National Trauma Data Bank and Pediatric Health Information Systems records, severe (emergency department Glasgow Coma Scale, < 8) traumatic brain injury, hospital length of stay more than 24 hours, and nonmissing disposition.
Interventions:
None.
Measurements And Main Results:
The outcome was posttraumatic seizures, identified using validated International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Prespecified candidate predictors of posttraumatic seizures included age, injury mechanism, emergency department Glasgow Coma Scale, intracranial hemorrhage type, hypoxia, hypotension, and cardiac arrest. Posttraumatic seizures were diagnosed in 25.2% of children with severe traumatic brain injury. In those without abuse/assault or subdural hemorrhage, the posttraumatic seizures rate varied between 36.6% in those less than 2 years old and 16.4% in those 14-17 years old. Age, abusive mechanism, and subdural hemorrhage are each significant predictors of posttraumatic seizures. The risk of posttraumatic seizures has a complex relationship with these predictors. The estimated odds of posttraumatic seizures decrease with advancing age, odds ratio equal to 0.929 (0.905-0.954) per additional year of age with no abuse/assault and no subdural hemorrhage; odds ratio equal to 0.820 (0.730-0.922) per additional year of age when abuse and subdural hemorrhage are present. An infant with accidental traumatic brain injury and subdural hemorrhage has approximately the same estimated probability of posttraumatic seizures as an abused infant without subdural hemorrhage (47% [95% CI, 39-55%] vs 50% [95% CI, 41-58%]; p = 0.69). The triad of young age, injury by abuse/assault, and subdural hemorrhage confers the greatest estimated probability for posttraumatic seizures (60% [95% CI, 53-66%]).
Conclusions:
Posttraumatic seizures risk in children with severe traumatic brain injury is greatest with a triad of younger age, injury by abuse/assault, and subdural hemorrhage. However, posttraumatic seizures are common even in the absence of these factors.
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