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Published on: June 21, 2019
Incidence of traumatic brain injuries in head-injured children with seizures
Meredith L Borland1,2, Stuart R Dalziel3,4, Natalie Phillips5,6
1Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
Insights
Post-traumatic seizures (PTS) are uncommon in head-injured children but significantly increase the risk of clinically important traumatic brain injury (ciTBI), especially with lower Glasgow Coma Scale (GCS) scores on arrival.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Outcomes Research
Background:
- Clinically important traumatic brain injury (ciTBI) outcomes in pediatric head-injured patients with post-traumatic seizures (PTS) are not well-documented.
- Understanding the incidence and short-term outcomes of ciTBI in this specific population is crucial for clinical management.
Purpose of the Study:
- To determine the incidence and short-term outcomes of ciTBI in head-injured children presenting to the emergency department (ED) with PTS.
- To identify clinical predictors and associated outcomes, particularly the Glasgow Coma Scale (GCS) score, in children with PTS.
Main Methods:
- Secondary analysis of a prospective observational study involving 10 Australasian Paediatric Research in Emergency Departments International Collaborative (PREDICT) network EDs.
- Data collected from 2011-2014 on head-injured children (<18 years) with and without PTS.
- Analysis of clinical predictors and outcomes using attributable risk (AR) and risk ratios (RR), including GCS scores.
Main Results:
- PTS occurred in 1.7% of 20,137 head injuries. The ciTBI rate was 10.1% in children with PTS versus 1.1% without PTS.
- Reduced GCS scores on arrival were strongly associated with increased ciTBI risk in children with PTS.
- Children with PTS and GCS ≤13 had higher rates of admission, intubation, and neurosurgery, with two deaths observed in this subgroup.
Conclusions:
- Post-traumatic seizures (PTS) are an uncommon but significant indicator of potential ciTBI in head-injured children.
- The risk of ciTBI in children with PTS is substantially elevated, particularly when accompanied by a reduced Glasgow Coma Scale (GCS) score upon presentation to the ED.
Objective:
Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature.
Methods:
Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Departments International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children <18 years with and without PTS. Clinical predictors and outcomes were analysed by attributable risk (AR), risk ratios (RR) and 95% confidence interval (CI), including the association with Glasgow Coma Scale (GCS) scores.
Results:
Of 20 137 head injuries, 336 (1.7%) had PTS with median age of 4.8 years. Initial GCS was 15 in 268/336 (79.8%, AR -16.1 [95% CI -20.4 to -11.8]), 14 in 24/336 (7.1%, AR 4.4 [95% CI 1.6-7.2]) and ≤13 in 44/336 (13.1%, AR 11.7 [95% CI 8.1-15.3]) in comparison with those without PTS, respectively. The ciTBI rate was 34 (10.1%) with PTS versus 219 (1.1%) without PTS (AR 9.0 [95% CI 5.8-12.2]) with 5/268 (1.9%), 6/24 (25.0%) and 23/44 (52.3%) with GCS 15, 14 and ≤13, respectively. In PTS, rates of admission ≥2 nights (34 [10.1%] AR 9.0 [95% CI 5.8-12.3]), intubation >24 h (9 [2.7%] AR 2.5 [95% CI 0.8-4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4-3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13.
Conclusions:
PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival.
