Seizures After Traumatic Brain Injury: Conduct CT

Abstract

Research Article| September 01 2017 Seizures After Traumatic Brain Injury: Conduct CT AAP Grand Rounds (2017) 38 (3): 32. https://doi.org/10.1542/gr.38-3-32 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Seizures After Traumatic Brain Injury: Conduct CT. AAP Grand Rounds September 2017; 38 (3): 32. https://doi.org/10.1542/gr.38-3-32 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: seizures, traumatic brain injuries Source: Badawy MK, Dayan PS, Tunik MG, et al. Prevalence of brain injuries and recurrence of seizures in children with posttraumatic seizures. Acad Emerg Med. 2017; 24(5): 595– 605; doi: https://doi.org/10.1111/acem.13168Google Scholar Investigators from the Pediatric Emergency Care Applied Research Network (PECARN) conducted a secondary analysis to evaluate the frequency of traumatic brain injuries (TBIs) and short-term seizure recurrence in children with posttraumatic seizures (PTS). Children who were <18 years old and received blunt head trauma that was evaluated at 1 of 25 participating PECARN EDs from 2004 to 2006 were included. All clinical data were obtained via chart review. The main exposure was PTS, defined as a witnessed seizure episode that occurred after the traumatic event. PTS timing was categorized as immediate (on impact), within 30 minutes, or >30 minutes after the traumatic event. PTS duration was categorized as <1 minute, 1 to <5 minutes, 5–15 minutes, and >15 minutes. The main outcome measures were (a) the presence of TBIs on CT images, defined as the presence of any intracranial hemorrhage, cerebral edema, pneumocephalus, or skull fracture; (b) the need for neurosurgical intervention; and (c) recurrent seizures within 1 week of the ED visit. Investigators calculated the frequencies of each outcome, the type of TBIs identified, the association of PTS timing and duration with presence of TBI, and the frequencies of neurosurgical intervention and recurrent seizures in those with PTS but no TBI. There were 42,424 participants included in the analysis, with 536 (1.3%) having PTS. Of those with PTS who had CT results (n = 466), 72 had TBIs (15.4%). The most common TBIs identified were cerebral contusion (5.6%) and subarachnoid hemorrhage (5.4%). The frequency of TBI increased as the timing and duration of PTS increased. Of the 72 patients with PTS who had TBIs on CT images, 20 (27.8%) underwent neurosurgery, and 15 (20.8%) had recurrent seizures. Of those with no TBI on CT images or no CT performed (n = 457), 5 (1.1%) had recurrent seizures, and none required neurosurgical intervention. The investigators conclude that children with PTS have a high likelihood of TBI on CT images, and a high proportion of those with TBI on CT images require neurosurgical interventions and have recurrent seizures. Dr Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. TBIs are known to cause early and late PTS. Risk factors for “early” PTS (occurring within 7 days of injury) include severe and/or penetrating brain injuries, subdural hematoma, cerebral contusions, depressed skull fractures, retained bone or metal fragments, focal neurological deficits, loss of consciousness, Glasgow Coma Scale (GCS) score <10, prolonged posttraumatic amnesia, and age <2 years.1 The incidence and prognosis of early PTS have been more closely evaluated for pediatric severe TBI (GCS 3–8) when compared to moderate (GCS 9–12) or mild (13–15) TBI. The results of the current... You do not currently have access to this content.