Introduction: Post-traumatic seizures (PTS) are a common complication following a TBI and may lead to post-traumatic epilepsy. PTS is well described in the adult literature, but has not been studied extensively in children. Here, we utilized the largest nationwide registry of pediatric hospitalizations to report the national incidence, risk factors, and outcomes associated with PTS in pediatric TBI.

Methods: We queried the Kids Inpatient Database to identify all patients (age <21) that had a primary diagnosis of TBI (850.xx-854.xx) and a secondary diagnosis of PTS (780.33, 780.39). Parameters of interest included demographics, pre-existing comorbidities, hospital characteristics, injury type (concussion, laceration/contusion, SAH/SDH/EDH), loss of consciousness, surgical management, discharge disposition, in-hospital complications, and in-hospital mortality.

Results: The prevalence of PTS was 6.9% among 124,444 patients hospitalized for TBI. Prevalence was impacted by LOC: no LOC (6.3%), brief LOC (7.5%), moderate LOC (10.6%), prolonged LOC w/baseline return (13.9%), or prolonged LOC w/no return (6.4%). Prevalence also varied by type of TBI: subdural hematoma (12.0%), cerebral laceration (7.4%), subarachnoid hemorrhage (6.5%), concussion (6.0%), and epidural hematoma (4.0%). In multivariable analysis, risk factors for PTS included age 0-5yo, African American race (Odds Ratio[OR]: 1.3), 1+ pre-existing comorbidities (OR: 2.0), cerebral contusion/laceration (OR: 1.2), subdural hematoma (OR: 1.6), closed injury (OR: 2.3), brief LOC (OR: 1.5), moderate LOC (OR: 1.5), and prolonged LOC w/baseline return (OR: 1.8). Surgically managed patients were more likely to suffer PTS (OR: 1.6) unless treated within 24 hours of admission (OR: 0.8). PTS was associated with increased likelihood of in-hospital complications (OR: 1.7) and adverse (non-routine) discharge disposition (OR: 1.2), but not in-hospital mortality (OR: 0.5).

Conclusions: Independent risk factors for PTS include younger age (< 5), African American race, increased preexisting comorbidity, prolonged LOC, and injury pattern involving cortical exposure to blood products. However, patients surgically evacuated urgently are less likely to develop PTS.

Patient Care: This research may help to identify at risk patients following traumatic brain injury for further study in seizure prophylaxis. This is of particular importance in the pediatric population and longer lifespan.

Learning Objectives: 1) Learners will be familiarized with the incidence of post-traumatic seizures in the pediatric population. 2) Learners will be familiarized with the risk factors for post-traumatic seizures and be better able to identify populations most at risk. 3) Learners will be familiarized with long-term outcomes of post-traumatic seizures in the pediatric population.

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