914

Abstract

Introduction: Administration of seizure prophylaxis is routinely provided by many clinicians after traumatic brain injury. The most recent guidelines from the Brain Trauma Foundation weakly recommend the practice and suggest provision of anti-epileptics only for the prevention of early-seizures. Previous literature suggests that the incidence of post-traumatic seizure ranges from 10 to 40% in patients not receiving prophylaxis. Much of this literature is over 20 years old. Since that time, clinicians have developed a better understanding of traumatic brain injury and great advances have been made in the care of the critically ill patient. Furthermore, the use of seizure prophylaxis is not without potential pitfalls including the potential for adverse effects, drug interactions and increased drug cost. Our local practice during the study period was not to provide seizure prophylaxis unless patients became symptomatic. Methods: This retrospective cohort study included all adult patients admitted to University of South Alabama Medical Center with blunt or penetrating head trauma from September 2009- December 2012. Patients were identified using the local trauma registry database. Patients with seizure were identified using ICD-09 codes significant for seizures. Patients were excluded if they were on any anti-epileptic medications prior to hospitalization. We sought to investigate whether patients who didn't receive seizure prophylaxis had a higher incidence of post-traumatic seizure compared to previous medical literature. Additional study goals include comparison of patients who did and did not develop seizure during their hospital stay. Results: 1203 patients met study criteria and were included in the analysis. Of those, 38 patients (2.9%) had at least one seizure during their hospital stay. No patients received seizure prophylaxis prior to seizure development. The mean Injury Severity Score (ISS) for all patients was 20, with most patients having experienced blunt trauma (88.9%). Mean admission Glasgow Coma Score (GCS) for all patients was 10. No differences were noted in severity of injury, mechanism of injury and admission GCS among patients who developed seizure compared to those who did not. ICU length of stay (8.1 vs. 7.3 days) and hospital length of stay (10.9 vs. 8.7 days) were similar between the two groups, respectively. The in-hospital death rate was lower in the patients who experienced seizure during their hospital stay (8.3% vs. 13.9%). The rate of patients who were discharged to a medical facility or required home-health care after discharge did not differ among patients who developed an in-hospital seizure compared to those who did not (16.6% vs. 17.6%). Conclusions: Our study suggests that the rate of seizure after traumatic brain injury is much lower than rates described in previous literature. These findings may be explained by improvements in overall management of traumatic brain injury. Our study suggests that the development of a seizure during hospital stay did not have a detrimental effect on patient outcomes including mortality, hospital length of stay, ICU length of stay and post-discharge disposition, respectively. These findings are hypothesis-generating and need to be confirmed in a larger, multicenter randomized study.