Abstract
The use of prophylactic anticonvulsants to prevent early post-traumatic seizures (PTSs) is recommended but inconsistently employed in patients with traumatic brain injury (TBI). The authors evaluated outcomes associated with prophylaxis administration in patients with TBI at a Level 1 trauma center. All patients admitted with TBI from October 2007 through May 2012 were included. Our primary outcome was the incidence of early PTSs. Secondary outcomes included mortality, length of hospital and intensive care unit (ICU) stays, and incidence of late seizures. Of the 2,111 patients with TBI, 557 (26.4%) received seizure prophylaxis and 1,554 (73.6%) did not. Two early PTSs occurred in the prophylaxis group (0.4%), whereas 21 occurred in the non-prophylaxis group (1.4%) (p = 0.05). The overall mortality rate was higher in patients who received prophylaxis (14.2% vs. 6.2%; p < 0.001), and the mean hospital length of stay (LOS) was longer (6.8 ± 6.9 vs. 3.8 ± 5 days; p < 0.001). In patients with severe and moderate TBI, the rate of prophylaxis administration was approximately half, whereas significantly fewer patients with mild TBI received prophylaxis than did not (20.2% vs 79.8%, p < 0.001). Lower Glasgow Coma Scale (GCS) score and longer hospital LOS were associated with early PTS (p = 0.008 for both comparisons), but sex and age were not. Brain hemorrhage was present in 78.3% of those patients who experienced early seizures. In our cohort, patients who received seizure prophylaxis had a lower GCS score, higher overall mortality rate, longer LOS, and more frequent ICU admissions, suggesting that patients who received prophylaxis were likely more severely injured.
Highlights
1.7 million traumatic brain injuries (TBIs) occur in the US each year, and they result in about 52,000 deaths [1]
The primary outcome measure was the incidence of early post-traumatic seizures (PTSs); we compared the incidence among the group of patients who received seizure prophylaxis with the incidence among those who did not
Hierarchical binary logistic regression was performed to account for the influence of Glasgow Coma Scale (GCS), hospital length of stay (LOS), sex, and age while evaluating the influence of prophylaxis on PTS. These results showed that low GCS score and longer hospital LOS were associated with early PTS (p = 0.008, OR = 0.89, and p = 0.008, OR = 1.06, respectively)
Summary
1.7 million traumatic brain injuries (TBIs) occur in the US each year, and they result in about 52,000 deaths [1]. The Brain Trauma Foundation guidelines recommend the use of prophylactic anticonvulsant medications to prevent early PTSs, even though early PTSs are not associated with worse outcomes [2, 6,7,8]. This recommendation is based on conflicting results from studies that were based on the use of phenytoin and valproic acid [6,7,8,9].
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