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.

Citation

Borland, M. L., Dalziel, S. R., Phillips, N., Dalton, S., Lyttle, M. D., Bressan, S., …Babl, F. E. (2023). Incidence of traumatic brain injuries in head-injured children with seizures. Emergency Medicine Australasia, 35(2), 289-296. https://doi.org/10.1111/1742-6723.14112

• 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