In:
Epilepsia, Wiley, Vol. 54, No. 10 ( 2013-10), p. 1780-1788
Abstract:
Traumatic brain injury ( TBI ) is an important cause of morbidity and mortality in children, and early posttraumatic seizures ( EPTS ) are a contributing factor to ongoing acute damage. Continuous video‐ EEG monitoring ( cEEG ) was utilized to assess the burden of clinical and electrographic EPTS . Methods Eighty‐seven consecutive, unselected (mild – severe), acute TBI patients requiring pediatric intensive care unit ( PICU ) admission at two academic centers were monitored prospectively with cEEG per established clinical TBI protocols. Clinical and subclinical seizures and status epilepticus ( SE , clinical and subclinical) were assessed for their relation to clinical risk factors and short‐term outcome measures. Key Findings Of all patients, 42.5% (37/87) had seizures. Younger age (p = 0.002) and injury mechanism (abusive head trauma – AHT , p 〈 0.001) were significant risk factors. Subclinical seizures occurred in 16.1% (14/87), while 6.9% (6/87) had only subclinical seizures. Risk factors for subclinical seizures included younger age (p 〈 0.001), AHT (p 〈 0.001), and intraaxial bleed (p 〈 0.001). SE occurred in 18.4% (16/87) with risk factors including younger age (p 〈 0.001), AHT (p 〈 0.001), and intraaxial bleed (p = 0.002). Subclinical SE was detected in 13.8% (12/87) with significant risk factors including younger age (p 〈 0.001), AHT (p = 0.001), and intraaxial bleed (p = 0.004). Subclinical seizures were associated with lower discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) score (p = 0.002). SE and subclinical SE were associated with increased hospital length of stay (p = 0.017 and p = 0.041, respectively) and lower hospital discharge KOSCHI (p = 0.007 and p = 0.040, respectively). Significance cEEG monitoring significantly improves detection of seizures/SE and is the only way to detect subclinical seizures/ SE . cEEG may be indicated after pediatric TBI , particularly in younger children, AHT cases, and those with intraaxial blood on computerized tomography ( CT ).
Type of Medium:
Online Resource
ISSN:
0013-9580
,
1528-1167
DOI:
10.1111/epi.2013.54.issue-10
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2002194-X
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