Seizure Prophylaxis Following Moderate to Severe Traumatic Brain Injury: Retrospective Investigation of Clinical Practice and the Impact of Clinical Guidelines.

Heather Nichol,Jessica Trier,John Boyd

doi:10.7759/cureus.7709

Abstract

BackgroundPost-traumatic seizure (PTS) is a major complication of traumatic brain injury (TBI). However, there has been controversy in the literature regarding whether anticonvulsants should be used prophylactically to prevent it, and there is significant variability in practice. The objective of this study is to describe seizure prophylaxis practices after moderate to severe TBI and to determine whether the use of seizure prophylaxis increased following the recommendations of the Quebec Institut National d'Excellence en Santé et Services Sociaux and the Ontario Neurotrauma Foundation (INESSS-ONF) guidelines. This study will also compare the characteristics of patients who receive the recommended prophylaxis and those who do not.MethodsAll adult patients admitted to a level-1 trauma centre for moderate to severe TBI were eligible for this study (n = 96). Medical records including patient age, sex, Glasgow Coma Scale (GCS) score, mechanism of injury, and occurrence of PTS were reviewed in a retrospective manner regarding the administration of recommended seizure prophylaxis.ResultsThe proportion of patients receiving the recommended seizure prophylaxis was 8%. There was no significant increase after the release of the INESSS-ONF guidelines (p: 0.38). There were no significant differences in demographics, injury characteristics, or rates of early PTS between patients receiving the recommended prophylaxis and those not receiving it (p: >0.05).ConclusionThe results indicate that the use of the recommended seizure prophylaxis after moderate to severe TBI is low and that the release of the INESSS-ONF guidelines did not increase its use. Patient and injury factors do not appear to influence the use of seizure prophylaxis. These results highlight variability in seizure prophylaxis practices and the importance of understanding local practice patterns. Implementation strategies should be identified to increase adherence to the recommendations and improve patient care.

Highlights

IntroductionAn estimated 69 million people suffer from traumatic brain injury (TBI) every year, with the highest incidence in North America and Europe [1]; 19% of these injuries, or 13 million cases annually, are classified as moderate or severe TBI, defined by longer loss of consciousness and post-traumatic amnesia, and more significant impairment in the level of consciousness [1,2]
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide
The results indicate that the use of the recommended seizure prophylaxis after moderate to severe traumatic brain injury (TBI) is low and that the release of the INESSS-ONF guidelines did not increase its use

Summary

Introduction

An estimated 69 million people suffer from TBIs every year, with the highest incidence in North America and Europe [1]; 19% of these injuries, or 13 million cases annually, are classified as moderate or severe TBI, defined by longer loss of consciousness and post-traumatic amnesia, and more significant impairment in the level of consciousness [1,2]. These types of severe injuries confer a significant burden on patients and the healthcare system as they are associated with a higher risk for significant short- and long-term complications [2]. This study will compare the characteristics of patients who receive the recommended prophylaxis and those who do not

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