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Early posttraumatic seizures in pediatric traumatic brain injury: a multicenter analysis
Shu-Ling Chong1,2, Suyun Qian3, Sarah Hui Wen Yao1
11Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
Insights
Early posttraumatic seizures (EPTSs) are common in children with traumatic brain injury (TBI) in Asia. These seizures are linked to worse functional outcomes in survivors but do not increase the risk of death.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Traumatology
Background:
- Early posttraumatic seizures (EPTSs) in children following traumatic brain injury (TBI) exacerbate metabolic stress on the developing brain.
- Understanding predictors and outcomes of EPTSs is crucial for managing pediatric TBI patients in Asian healthcare settings.
Purpose of the Study:
- To identify demographic and radiographic predictors of EPTSs in children with moderate to severe TBI in Asia.
- To investigate the association between EPTSs and mortality.
- To examine the link between EPTSs and poor functional outcomes in pediatric TBI survivors.
Main Methods:
- Secondary analysis of a retrospective cohort from the Pediatric Acute & Critical Care Medicine Asian Network.
- Included children under 16 with TBI and Glasgow Coma Scale (GCS) score ≤ 13.
- Logistic regression used to analyze risk factors and outcomes, with poor functional outcome defined by the Pediatric Cerebral Performance Category scale.
Main Results:
- Out of 313 children, 76 (24.3%) experienced EPTSs. Younger age was the only significant predictor of EPTSs (aOR 0.85).
- EPTSs were not associated with an increased risk of death (15.6% mortality).
- However, EPTSs were significantly associated with poor functional outcomes in survivors (aOR 2.08), after adjusting for multiple factors.
Conclusions:
- Early posttraumatic seizures are prevalent in Asian children with moderate to severe TBI.
- EPTSs are a significant risk factor for poor functional outcomes in pediatric TBI survivors.
- Further research into preventative and therapeutic strategies for EPTSs in this population is warranted.
Objective:
Early posttraumatic seizures (EPTSs) in children after traumatic brain injury (TBI) increase metabolic stress on the injured brain. The authors sought to study the demographic and radiographic predictors for EPTS, and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes among children with moderate to severe TBI in Asia.
Methods:
A secondary analysis of a retrospective TBI cohort among participating centers of the Pediatric Acute & Critical Care Medicine Asian Network was performed. Children < 16 years of age with a Glasgow Coma Scale (GCS) score ≤ 13 who were admitted to pediatric intensive care units between January 2014 and October 2017 were included. Logistic regression analysis was performed to study risk factors for EPTS and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes. Poor functional outcomes were defined as moderate disability, severe disability, and coma as defined by the Pediatric Cerebral Performance Category scale.
Results:
Overall, 313 children were analyzed, with a median age of 4.3 years (IQR 1.8-8.9 years); 162 children (51.8%) had severe TBI (GCS score < 8), and 76 children (24.3%) had EPTS. After adjusting for age, sex, and the presence of nonaccidental trauma (NAT), only younger age was significantly associated with EPTS (adjusted odds ratio [aOR] 0.85, 95% CI 0.78-0.92; p < 0.001). Forty-nine children (15.6%) in the cohort died, and 87 (32.9%) of the 264 surviving patients had poor functional outcomes. EPTS did not increase the risk of death. After adjusting for age, sex, TBI due to NAT, multiple traumas, and a GCS score < 8, the presence of EPTS was associated with poor functional outcomes (aOR 2.08, 95% CI 1.05-4.10; p = 0.036).
Conclusions:
EPTSs were common among children with moderate to severe TBI in Asia and were associated with poor functional outcomes among children who survived TBI.
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