Variation in seizure prophylaxis in severe pediatric traumatic brain injury

Paige J. Ostahowski, Nithya Kannan, Mark S. Wainwright, Qian Qiu, Richard B. Mink, Jonathan I. Groner, Michael J. Bell, Christopher C. Giza, Douglas F. Zatzick, Richard G. Ellenbogen, Linda Ng Boyle, Pamela H. Mitchell, Monica S. Vavilala*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objective Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. Methods In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ? 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head Abbreviated Injury Scale score ? 3) who received tracheal intubation for ? 48 hours in the ICU between 2007 and 2011. Results Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). Conclusions While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.

Original languageEnglish (US)
Pages (from-to)499-506
Number of pages8
JournalJournal of Neurosurgery: Pediatrics
Volume18
Issue number4
DOIs
StatePublished - Oct 2016

Keywords

  • Antiepileptic medications
  • Epilepsy
  • Pediatrics
  • Seizures
  • Trauma
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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