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Seizure Prophylaxis in Patients with Traumatic Brain Injury: A Single-Center Study

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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.

No MeSH data available.


Graph illustrating length of stay in the hospital and in the ICU for patients with TBI
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FIG3: Graph illustrating length of stay in the hospital and in the ICU for patients with TBI

Mentions: Ninety-five percent of patients who received seizure prophylaxis were admitted to the ICU from the emergency department, whereas 51% of patients who received no prophylaxis were admitted (p < 0.001). Of those patients admitted to the ICU, the patients who received prophylaxis had a mean ICU LOS of 4.5 ± 5.6 days, whereas the mean ICU LOS in the patients who did not receive prophylaxis was 2.9 ± 4.9 days (p < 0.001). Hospital LOS was also longer in the patients who received prophylaxis than in those who did not (6.8 ± 6.9 days vs. 3.8 ± 5 days, p < 0.001) (Figure 3).


Seizure Prophylaxis in Patients with Traumatic Brain Injury: A Single-Center Study
Graph illustrating length of stay in the hospital and in the ICU for patients with TBI
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037062&req=5

FIG3: Graph illustrating length of stay in the hospital and in the ICU for patients with TBI
Mentions: Ninety-five percent of patients who received seizure prophylaxis were admitted to the ICU from the emergency department, whereas 51% of patients who received no prophylaxis were admitted (p < 0.001). Of those patients admitted to the ICU, the patients who received prophylaxis had a mean ICU LOS of 4.5 ± 5.6 days, whereas the mean ICU LOS in the patients who did not receive prophylaxis was 2.9 ± 4.9 days (p < 0.001). Hospital LOS was also longer in the patients who received prophylaxis than in those who did not (6.8 ± 6.9 days vs. 3.8 ± 5 days, p < 0.001) (Figure 3).

View Article: PubMed Central - HTML - PubMed

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 &lt; 0.001), and the mean hospital length of stay (LOS) was longer (6.8 &plusmn; 6.9 vs. 3.8 &plusmn; 5 days; p &lt; 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 &lt; 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.

No MeSH data available.