Introduction: Post-traumatic epilepsy rates are reported as high as 19% in severe pediatric TBI. There is less data on outcomes after minor TBI, and evidence from adults with minor TBI demonstrated a negligible risk of post-traumatic epilepsy. Inpatient electroencephalogram (EEG) monitoring is becoming more widely available but there are no guidelines for its use in pediatric traumatic brain injury.
Methods: All patients admitted to the pediatric neurosurgery service after blunt head trauma who did not require surgery or intracranial pressure monitoring over a 4-year period were included, totaling 935 patients. Patients admitted to the general surgery service for multi-organ trauma and patients suffering non-accidental trauma were excluded. Hospital system EEG records over the same period were cross-referenced to trauma patients, capturing all patients who underwent EEG, both in- and out-patient.
Results: Average age was 4.7 years old, with a standard deviation of 5.5 years. 64% of patients were male. The most common cause of injury was a fall. 69% of patients had a skull fracture, 38% had extra-axial hemorrhage, 26% had intra-axial hemorrhage. 22% of patients experienced loss of consciousness and 10% were reported to have a pre-hospital seizure, though only 1% had seizures while in hospital. Ten patients underwent EEG monitoring and one patient had documented seizures on EEG, though only 33% had normal EEGs. 3% of patients overall were discharged on antiepileptic medication. No patients had a persistent seizure disorder documented after an average 24 months follow up.
Conclusions: There is poor correlation between pre-hospital seizure reports and documented in-hospital seizure activity. EEG likely has little utility in the setting of minor TBI. Non-operative TBI patients are unlikely to need anti-epileptics on discharge, especially if they exhibit no seizure activity while hospitalized considering the extremely low rate of post-traumatic epilepsy in this population.
Patient Care: - help physicians reduce unhelpful tests after minor TBI
- help physicians determine appropriate follow up for children with minor TBI
Learning Objectives: By the conclusion of this session, participants should be able to:
1) identify the characteristics of pediatric patients with minor TBI
2) discuss different strategies for antiepileptic use in minor TBI
3) understand the utility of using EEG to assess for post-traumatic epilepsy
References: 1. Arango JI, Deibert CP, Brown D, Bell M, Dvorchik I, Adelson PD: Posttraumatic seizures in children with severe traumatic brain injury. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 28:1925-1929, 2012.
2. Greenberg JK, Stoev IT, Park TS, Smyth MD, Leonard JR, Leonard JC, Pineda JA, Limbrick DD: Management of children with mild traumatic brain injury and intracranial hemorrhage. The journal of trauma and acute care surgery 76:1089-1095, 2014.
3. Quigley MR, Chew BG, Swartz CE, Wilberger JE: The clinical significance of isolated traumatic subarachnoid hemorrhage. The journal of trauma and acute care surgery 74:581-584, 2013.