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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.

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Graph demonstrating rates of prophylaxis administration to patients with TBI by Glasgow Coma Scale score
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FIG4: Graph demonstrating rates of prophylaxis administration to patients with TBI by Glasgow Coma Scale score

Mentions: Among patients who experienced seizures, 78.3% had visible intracranial blood on the admission CT scan. Subdural hematoma was present in 27.8% of cases, intraparenchymal hemorrhage was present in 11.1%, and a combination of bleed type was present in half of all seizure cases. Patients in the prophylaxis group were older than those in the non-prophylaxis group (average age: 56 years vs. 46.5 years, p < 0.001). Prophylaxis administration did not differ by sex: 25.8% of females and 27.7% of males were given prophylaxis. Mild TBI (as assessed by GCS) accounted for 80.6% of all TBI, whereas 3.9% were moderate and 15.5% were severe. Of all patients with either severe or moderate TBI, similar proportions received prophylaxis versus no prophylaxis (48.8% vs 51.2%, p = 0.73, and 51.3% vs 48.7%, p = 0.91, respectively). In contrast, fewer patients with mild TBI received prophylaxis than did not (20.2% vs 79.8%, p < 0.001) (Figure 4).


Seizure Prophylaxis in Patients with Traumatic Brain Injury: A Single-Center Study
Graph demonstrating rates of prophylaxis administration to patients with TBI by Glasgow Coma Scale score
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG4: Graph demonstrating rates of prophylaxis administration to patients with TBI by Glasgow Coma Scale score
Mentions: Among patients who experienced seizures, 78.3% had visible intracranial blood on the admission CT scan. Subdural hematoma was present in 27.8% of cases, intraparenchymal hemorrhage was present in 11.1%, and a combination of bleed type was present in half of all seizure cases. Patients in the prophylaxis group were older than those in the non-prophylaxis group (average age: 56 years vs. 46.5 years, p < 0.001). Prophylaxis administration did not differ by sex: 25.8% of females and 27.7% of males were given prophylaxis. Mild TBI (as assessed by GCS) accounted for 80.6% of all TBI, whereas 3.9% were moderate and 15.5% were severe. Of all patients with either severe or moderate TBI, similar proportions received prophylaxis versus no prophylaxis (48.8% vs 51.2%, p = 0.73, and 51.3% vs 48.7%, p = 0.91, respectively). In contrast, fewer patients with mild TBI received prophylaxis than did not (20.2% vs 79.8%, p < 0.001) (Figure 4).

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.


Related in: MedlinePlus