Early posttraumatic seizures in pediatric traumatic brain injury: a multicenter analysis

Chong SL 1 , Qian S 2 , Yao SHW 1 , Allen JC 3 , Dang H 4 , Chan LCN 5 Show all authors , Ming M 6 , Gan CS 7 , Ong JSM 8 , Kurosawa H 9 , Lee JH 10

Affiliations 

  • 1 1Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
  • 2 3Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
  • 3 4Centre for Quantitative Medicine, Duke-NUS, Singapore
  • 4 5Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China
  • 5 6Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  • 6 7Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
  • 7 8Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 8 9Khoo Teck Puat National University Children's Medical Institute, National University Hospital, Singapore
  • 9 11Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; and
  • 10 2SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, Singapore
J Neurosurg Pediatr, 2022 Feb 01;29(2):225-231.
PMID: 34715667 DOI: 10.3171/2021.8.PEDS21281

Abstract

OBJECTIVE: Early posttraumatic seizures (EPTSs) in children after traumatic brain injury (TBI) increase metabolic stress on the injured brain. The authors sought to study the demographic and radiographic predictors for EPTS, and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes among children with moderate to severe TBI in Asia.

METHODS: A secondary analysis of a retrospective TBI cohort among participating centers of the Pediatric Acute & Critical Care Medicine Asian Network was performed. Children < 16 years of age with a Glasgow Coma Scale (GCS) score ≤ 13 who were admitted to pediatric intensive care units between January 2014 and October 2017 were included. Logistic regression analysis was performed to study risk factors for EPTS and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes. Poor functional outcomes were defined as moderate disability, severe disability, and coma as defined by the Pediatric Cerebral Performance Category scale.

RESULTS: Overall, 313 children were analyzed, with a median age of 4.3 years (IQR 1.8-8.9 years); 162 children (51.8%) had severe TBI (GCS score < 8), and 76 children (24.3%) had EPTS. After adjusting for age, sex, and the presence of nonaccidental trauma (NAT), only younger age was significantly associated with EPTS (adjusted odds ratio [aOR] 0.85, 95% CI 0.78-0.92; p < 0.001). Forty-nine children (15.6%) in the cohort died, and 87 (32.9%) of the 264 surviving patients had poor functional outcomes. EPTS did not increase the risk of death. After adjusting for age, sex, TBI due to NAT, multiple traumas, and a GCS score < 8, the presence of EPTS was associated with poor functional outcomes (aOR 2.08, 95% CI 1.05-4.10; p = 0.036).

CONCLUSIONS: EPTSs were common among children with moderate to severe TBI in Asia and were associated with poor functional outcomes among children who survived TBI.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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