Incidence of traumatic brain injuries in head-injured children with seizures

Borland, Meredith L.; Dalziel, Stuart R; Phillips, Natalie; Dalton, Sarah; Lyttle, Mark D; Bressan, Silvia; Oakley, Ed; Kochar, Amit; Furyk, Jeremy; Cheek, John A.; Neutze, Jocelyn; Eapen, Nitaa; Hearps, Stephen JC; Rausa, Vanessa C; Babl, Franz E.

Abstract

Objective: Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature. Methods: Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Department International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children <18 years with and without PTS. Clinical predictors and outcomes were analysed by attributable risk (AR), risk ratios (RR) and 95% confidence interval (CI), including the association with Glasgow Coma Scale (GCS) scores. Results: Of 20 137 head injuries, 336 (1.7%) had PTS with median age of 4.8 years. Initial GCS was 15 in 268/336 (79.8%, AR −16.1 [95% CI −20.4 to −11.8]), 14 in 24/336 (7.1%, AR 4.4 [95% CI 1.6–7.2]) and ≤13 in 44/336 (13.1%, AR 11.7 [95% CI 8.1–15.3]) in comparison with those without PTS, respectively. The ciTBI rate was 34 (10.1%) with PTS versus 219 (1.1%) without PTS (AR 9.0 [95% CI 5.8–12.2]) with 5/268 (1.9%), 6/24 (25.0%) and 23/44 (52.3%) with GCS 15, 14 and ≤13, respectively. In PTS, rates of admission ≥2 nights (34 [10.1%] AR 9.0 [95% CI 5.8–12.3]), intubation >24 h (9 [2.7%] AR 2.5 [95% CI 0.8–4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4–3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13. Conclusions: PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival.

• Journal Article Type: Article
• Acceptance Date: Oct 5, 2022
• Online Publication Date: Nov 2, 2022
• Publication Date: Apr 1, 2023
• Deposit Date: Nov 13, 2022
• Publicly Available Date: Nov 14, 2022
• Journal: EMA - Emergency Medicine Australasia
• Print ISSN: 1742-6731
• Electronic ISSN: 1742-6723
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 2
• Pages: 289-296
• DOI: https://doi.org/10.1111/1742-6723.14112
• Keywords: Acute brain injury, child, head injuries, seizures
• Public URL: https://uwe-repository.worktribe.com/output/10121790
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.14112