M. B. Singer1, B. Zangbar1, K. Williams1, B. Joseph1, A. Tang1, N. Kulvatunyou1, P. Rhee1, T. O’Keeffe1 1University Of Arizona,Division Of Trauma, Critical Care, Burns, And Emergency Surgery,Tucson, AZ, USA
Introduction: Patients who sustain traumatic brain injury (TBI) are at risk for post-traumatic seizures (PTS). The reported incidence of early PTS varies widely from 2% to 14% but there is disagreement over which patients are at highest risk. We hypothesize that the PTS rate is lower than previously reported and that specific types of brain injury are not predictive of PTS.
Methods: We conducted a retrospective cohort analysis of all TBI patients admitted to our level one academic trauma center over a nine year period (January 1, 2006 to December 31, 2015). Demographic and injury data including ISS, head AIS, TBI type, history of seizure disorder, time of seizure and prophylactic AED use were collected for all patients who experienced PTS. Seizures were defined by clinical criteria due to the fact that electroencephalography is not routinely performed at our institution. Multivariate logistic regression was used to identify independent predictors of PTS.
Results: 10,001 TBI patients were evaluated at our institution during the nine-year study period, 180 (1.8%) of whom experienced PTS. 63 (34.8%) of these patients seized in the field or in the trauma bay and 23 (12.7%) had a prior history of seizure disorder. Of the 118 patients who seized after hospital admission, 28 (23.7%) were receiving AED prophylaxis at the time of PTS. Head abbreviated injury scale (AIS) ? 3, injury severity score, and subdural hematoma were independent predictors of PTS (Table 1). PTS did not independently predict mortality.
Conclusion: The rate of PTS at our institution is significantly lower than other published reports. This may reflect a change in the natural history of PTS or changes in intensive care unit management. In light of the high rates of pre-admission and breakthrough PTS (approximately 50%), we question the effectiveness of routine AED prophylaxis in reducing early PTS. Specific risk factors for PTS remain elusive.
