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Clinical predictors of post-traumatic seizures in children with head trauma
R J Lewis1, L Yee, S H Inkelis
1Department of Emergency Medicine, University of California, Los Angeles School of Medicine, Harbor-UCLA Medical Center, Torrance.
Insights
A low Glasgow Coma Scale (GCS) score in pediatric head trauma patients predicts early post-traumatic seizures. Prophylactic phenytoin may reduce seizures in these high-risk children.
Area of Science:
- Pediatric Neurology
- Trauma Surgery
- Emergency Medicine
Background:
- Early post-traumatic seizures (PTS) are a concern in pediatric head trauma.
- Identifying risk factors is crucial for timely intervention and management.
Purpose of the Study:
- To identify clinical characteristics associated with early PTS in children with head trauma.
- To evaluate the predictive value of Glasgow Coma Scale (GCS) scores and other factors for PTS.
- To explore the potential role of phenytoin in preventing PTS.
Main Methods:
- Retrospective chart review of pediatric head trauma patients (3 months to 15 years).
- Analysis of clinical data, including loss of consciousness, CT scan findings, and GCS scores.
- Statistical analysis to determine associations and predictive factors for PTS.
Main Results:
- Of 194 patients, 9.3% experienced PTS.
- A low GCS score (3-8), loss of consciousness, and abnormal CT scans were associated with PTS.
- A low GCS score was the strongest predictor of PTS (38.7% vs. 3.8% in high GCS).
- Phenytoin treatment in children with low GCS scores showed a trend towards reduced PTS.
Conclusions:
- A GCS score of 3-8 is predictive of early PTS in pediatric head trauma.
- Findings support the hypothesis that prophylactic phenytoin may reduce PTS in pediatric head trauma patients with low GCS scores.
Study Objectives:
To determine the clinical characteristics associated with early post-traumatic seizures in children with head trauma. DESIGN, SETTING, AND TYPE OF PARTICIPANTS: Retrospective chart review; urban trauma center/pediatric emergency department. Trauma patients aged 3 months to 15 years given discharge diagnosis ICD-9-CM codes indicating head trauma and seen from 1988 to 1990 were eligible for the study.
Interventions:
None.
Measurements And Main Results:
Of 194 patients, 96% suffered blunt trauma and 53% had a loss of consciousness. Fifty-one percent of 141 computed tomography (CT) scans of the head were abnormal, most frequently demonstrating skull fractures (34%), subdural hematomas (15%), and cerebral contusions (14%). Eighteen patients (9.3%) suffered post-traumatic seizures. A loss of consciousness, a low Glasgow Coma Scale (GCS) score (3 to 8), and an abnormal CT scan were associated with post-traumatic seizures (P < .02, .001, and .02, respectively). However, only a low GCS score was predictive of post-traumatic seizures when these factors were considered simultaneously (P < .001), with 38.7% of patients with low GCS scores suffering post-traumatic seizures and 3.8% of patients with high GCS scores suffering post-traumatic seizures. In children with low GCS scores, treatment with phenytoin was associated with a decrease in post-traumatic seizures.
Conclusion:
In the pediatric head trauma patient, a GCS score of 3 to 8 appears to be predictive of post-traumatic seizures. The data from this retrospective study are consistent with the hypothesis that prophylactic phenytoin reduces post-traumatic seizures in the pediatric head trauma patient with a low GCS score.