Mapping the evidence-practice gap in pediatric post-traumatic seizures and post-traumatic epilepsy: A national...

Pediatric post-traumatic seizures (PTS) and post-traumatic epilepsy (PTE) remain largely managed through extrapolation from adult evidence, with limited pediatric-specific guidance. This study aimed to characterize current clinical practice among pediatric neurologists in Türkiye, quantify evidence-practice divergence, assess whether clinician characteristics explain this variation, and identify priority areas requiring consensus.

A national cross-sectional web-based survey including 15 items was conducted among actively practicing pediatric neurologists in Türkiye. Post-traumatic seizures were framed as early (≤7 days) or late (>7 days) after injury; the survey addressed general PTS/PTE management and did not stratify items by traumatic brain injury (TBI) severity (mild, moderate, or severe). A total of 135 complete responses (approximately 30% of the 453 registered national society members) were analyzed. Consensus across decision nodes was classified using predefined thresholds, and a composite adult-guideline concordance score (0-1), benchmarked against adult neuro-trauma guidance used as a proxy, was constructed from four evidence-anchored practices. Associations between clinician characteristics and practice patterns were evaluated using multivariable and exploratory clustering analyses.

Prophylactic antiseizure treatment was nearly universal (99.3%, defined as any propensity other than "never"; 75.6% initiated usually or always), and levetiracetam was the predominant first-line agent (91.1%), representing the only domain reaching strong consensus. The most pronounced evidence-practice gap involved treatment duration: only 8.1% reported adult-guideline-concordant prophylaxis of ≤ 7 days, whereas 67.4% continued treatment beyond one month. Consensus was lacking for emergency imaging, follow-up electroencephalography, prophylaxis duration, and research priorities. Respondents met a median of two of the four evidence anchors (mean composite 0.51 ± 0.22), and the composite was treated as a formative index (a count of concordant practices) rather than as a latent construct; no demographic or professional characteristic independently predicted higher concordance, and the study was not powered to exclude modest associations. Practice clustering (exploratory) was consistent with agreement at established evidence nodes and divergence primarily where pediatric evidence remains limited.

Pediatric PTS/PTE management in Türkiye shows strong convergence in drug selection but substantial variation in duration and follow-up decisions, reflecting persistent pediatric evidence gaps and highlighting the need for pediatric-specific guidelines and national consensus initiatives.