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Published on: June 21, 2019
Posttraumatic epilepsy in intensive care unit-treated pediatric traumatic brain injury patients
Era D Mikkonen1,2, Markus B Skrifvars2, Matti Reinikainen3
1Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital & University of Helsinki, Helsinki, Finland.
Insights
Posttraumatic epilepsy (PTE) is common in pediatric traumatic brain injury (TBI) patients treated in the ICU. Higher age, moderate injury severity, and obliterated suprasellar cisterns are key risk factors for developing PTE.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Epileptology
Background:
- Posttraumatic epilepsy (PTE) is a recognized complication following traumatic brain injury (TBI).
- Existing research on PTE predominantly focuses on adult populations.
- There is a need to understand PTE risk factors specifically in pediatric TBI cases managed in intensive care units (ICUs).
Purpose of the Study:
- To identify clinical and radiological risk factors for PTE in pediatric TBI patients.
- To analyze data from a cohort of pediatric TBI patients treated in Finnish ICUs.
Main Methods:
- Retrospective analysis of the Finnish Intensive Care Consortium database (2003-2013).
- Inclusion of pediatric (<18 years) TBI patients treated in four academic university hospital ICUs.
- Definition of PTE as the need for oral antiepileptic medication at 6 months post-injury; risk factor assessment via multivariable logistic regression.
Main Results:
- Of 290 pediatric TBI patients, 59 (20%) developed PTE.
- Significant risk factors identified: increasing age (OR 1.08), obliterated suprasellar cisterns (OR 6.53), and moderate TBI severity (GCS 9-12 vs. 13-15, OR 2.88).
- Seizures during ICU stay and surgical treatment were also associated with increased PTE risk.
Conclusions:
- PTE is a frequent long-term outcome in pediatric TBI patients requiring ICU care.
- Age, injury severity, specific radiological findings (obliterated suprasellar cisterns), and ICU interventions influence PTE risk.
- Further research is warranted to develop strategies for PTE risk reduction in this vulnerable population.
Objective:
Posttraumatic epilepsy (PTE) is a well-described complication of traumatic brain injury (TBI). The majority of the available data regarding PTE stem from the adult population. Our aim was to identify the clinical and radiological risk factors associated with PTE in a pediatric TBI population treated in an intensive care unit (ICU).
Methods:
We used the Finnish Intensive Care Consortium database to identify pediatric (<18 years) TBI patients treated in four academic university hospital ICUs in Finland between 2003 and 2013. Our primary outcome was the development of PTE, defined as the need for oral antiepileptic medication in patients alive at 6 months. We assessed the risk factors associated with PTE using multivariable logistic regression modeling.
Results:
Of the 290 patients included in the study, 59 (20%) developed PTE. Median age was 15 years (interquartile range [IQR] 13-17), and 80% had an admission Glasgow Coma Scale (GCS) score ≤12. Major risk factors for developing PTE were age (adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00-1.16), obliterated suprasellar cisterns (OR 6.53, 95% CI 1.95-21.81), and an admission GCS score of 9-12 in comparison to a GCS score of 13-15 (OR 2.88, 95% CI 1.24-6.69).
Significance:
We showed that PTE is a common long-term complication after ICU-treated pediatric TBI. Higher age, moderate injury severity, obliterated suprasellar cisterns, seizures during ICU stay, and surgical treatment are associated with an increased risk of PTE. Further studies are needed to identify strategies to decrease the risk of PTE.
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