Patterns and Clinical Predictors of Antiseizure Medication Use in Pediatric Traumatic Brain Injury

Objective Current guidelines recommend the use of antiseizure medications (ASM) in pediatric patients with severe traumatic brain injury (TBI). This is based on low-quality evidence and can lead to variability in practice and over-prescription of medications. To understand factors influencing ASM prescription in pediatric TBI, we examined clinical variables associated with inpatient and discharge ASM prescription. Methods Multi-center, retrospective cohort study of patients aged 0 to 21 years, admitted with TBI to the intensive care units at two Level I trauma centers, from 2016 through 2024. Obtained demographic and clinical information from chart review. Neuroimaging and electroencephalogram findings were extracted from reports. Primary outcome measure was ASM administration during inpatient hospitalization. Secondary outcome measure was prescription of ASMs at discharge. We developed multivariable logistic regression models to identify factors associated with inpatient and discharge ASM prescription, and report adjusted odds ratios (OR) with 95% confidence intervals (CI). Results 467 patients met inclusion criteria. 287 (61%) patients were given an ASM during their hospitalization, and 159 (34%) patients were discharged from the hospital on an ASM. Factors associated with higher likelihood of inpatient ASM prescription include intracranial injury on imaging (OR 57, 95% CI 24-156), moderate Glasgow Coma Scale score of 9 to 12 (OR 21, 95% CI 2.4-354), neurology/neurosurgery admission (OR 11, 95% CI 3.1-42), and immediate seizures (OR 3.6, 95% CI 0.77-23). Clinical factors associated with greater likelihood of discharge ASM prescription were neuroimaging abnormalities (OR 8.5, 95% CI 4.0-20), immediate seizures (OR 6.1, 95% CI 1.9-22), and neurology/neurosurgery admission (OR 2.1, 95% CI 0.71-6.8). Conclusions Neuroimaging abnormalities, seizures, and admission to neurology or neurosurgery services were associated with greater likelihood of ASM prescription during hospitalization and at discharge. Future studies are needed to determine whether ASM prescription improves outcomes and optimize ASM use.