Abstract

BackgroundAntiepileptic agents are recommended to prevent early post-traumatic seizures (PTS) within seven days of injury in patients with severe traumatic brain injury (TBI). These agents are not routinely recommended for patients with mild-to-moderate TBI, defined as Glasgow Coma Scale (GCS) score > 8. At St. Joseph Mercy Oakland, levetiracetam (LEV) is commonly prescribed to prevent PTS. The objective of this study was to evaluate the appropriateness of LEV use in patients with mild, moderate, and severe TBI.MethodsThis retrospective cohort study evaluated the use of LEV in adult patients admitted with TBI over a five-year period. Patients who were younger than 18 years, had a history of seizures, were transferred to a tertiary center, or succumbed to their injuries were excluded. The primary outcome was appropriateness of LEV use. Secondary outcomes included duration of LEV treatment and rate of seizures.ResultsOf the 448 patients evaluated, 36 patients were excluded. Of the 412 included patients, 403 (97.8%) had a non-severe TBI, defined as GCS score > 8. In patients with non-severe TBI, 153 (38%) received LEV and 94 (23.3%) received LEV for more than seven days. Additionally, 105 (26.1%) patients with non-severe TBI were discharged with a prescription for LEV despite not having a seizure during hospitalization. All six patients with non-severe TBI who experienced a seizure were receiving LEV.ConclusionsInappropriate use of LEV is common in patients admitted with non-severe TBI, with many patients continuing LEV post-discharge. With careful patient selection, patients with mild and moderate TBI likely do not need seizure prophylaxis with LEV. Education on appropriate indication and duration of LEV in patients with TBI is warranted.

Highlights

  • Traumatic brain injury (TBI) is a leading cause of long-term neurological disability [1]

  • 105 (26.1%) patients with non-severe traumatic brain injury (TBI) were discharged with a prescription for LEV despite not having a seizure during hospitalization

  • Inappropriate use of LEV is common in patients admitted with non-severe TBI, with many patients continuing LEV post-discharge

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Summary

Introduction

Traumatic brain injury (TBI) is a leading cause of long-term neurological disability [1]. This risk is seen in patients with primarily a severe TBI, identified as a Glasgow Coma Scale (GCS) score of ≤8 These patients typically present with subdural hematoma, epidural hematoma, intracranial hematoma, linear/depressed fracture, or cortical contusion [4]. Mitigating such risks with a seven-day period of antiseizure medications is of high priority in the post-TBI period, as recommended by the Brain Trauma Foundation [5]. Antiepileptic agents are recommended to prevent early post-traumatic seizures (PTS) within seven days of injury in patients with severe traumatic brain injury (TBI) These agents are not routinely recommended for patients with mild-to-moderate TBI, defined as Glasgow Coma Scale (GCS) score > 8. The objective of this study was to evaluate the appropriateness of LEV use in patients with mild, moderate, and severe TBI

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