210 Post-Traumatic Seizure in Pediatric Traumatic Brain Injury

Abstract

Abstract INTRODUCTION Post traumatic seizures (PTS) are the most common complication following a traumatic brain injury (TBI). The nationwide incidence, risk factors, and outcomes associated with PTS in pediatric TBI are not well understood. METHODS We queried the Kids Inpatient Database (2003, 2006, 2009, 2012) using ICD-9-CM codes to identify all patients (age <21) that had a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis of a PTS (780.33, 780.39). Severity of TBI was determined by level of consciousness and nature of the injury (open/closed). Variables included demographics, comorbidity, hospital type, and TBI type. level of consciousness (LOC), open/closed wound, and surgical management. Risk factors for PTS were identified in univariate and multivariable analysis (alpha set at <0.05). RESULTS >The rate of PTS was 6.9% among 124,444 patients hospitalized for TBI. The rate was impacted by LOC: no LOC (6.3%), brief LOC (7.5%), moderate LOC (10.6%), prolonged LOC w/baseline return (13.9%), or prolonged LOC w/no return (6.4%). The rate also varied by type of TBI: subdural hematoma (12.0%), cerebral laceration (7.4%), subarachnoid hemorrhage (6.5%), concussion (6.0%), and epidural hematoma (4.0%). In multivariable analysis, risk factors for PTS included age 0–5 (compared to 6–10, 11–15, 16–20), African American race, 2 + pre-existing comorbidities, cerebral contusion/laceration, subdural hematoma, closed wound, brief LOC, moderate LOC, and prolonged LOC w/baseline return (all P < 0.05). Surgically managed patients were more likely to suffer PTS (10.7% vs. 6.5%, P < 0.0001) unless treated within 24 hours of admission (6.7% vs. 9.6%, P < 0.0001). CONCLUSION PTS is common in children with TBI and is impacted by age, comorbidity, race, and severity/type of injury. Patients with mild to moderate TBI are at the highest risk and prompt surgery is associated with decreased risk of PTS.