Introduction: Pediatric traumatic brain injury (TBI) remains one of the leading threats to long-term health and development in children worldwide. Long-term sequelae and potential sources of secondary injury following TBI include early post-traumatic seizures (EPTS) and post-traumatic epilepsy (PTE). Prophylactic administration of anti-epileptic drugs (AED) has been suggested as a potential mitigator and protective factor against EPTS and PTE. However, there is a dearth of research in large cohorts evaluating the effect of prophylactic AED administration on EPTS and PTE rates and current hospital practices.
Methods: Pediatric ( < 18 years) patients who presented to the Children’s Hospital of Pennsylvania with moderate or severe TBI (Glasgow Coma Scale ≤ 12) were retrospectively reviewed. We evaluated the association between prophylactic AED administration and incidence of EPTS and PTE and identified independent risk factors associated with administration of prophylactic AEDs via logistic regression.
Results: A total of 4357 patients were studied. Of these, 162 were considered to have received prophylactic AEDs. EPTS occurred in 2.53% and PTE in 5.33% of these patients. EPTS occurred in 0.078% and PTE in 1.52% of patients who did not receive prophylactic AEDs. Hospital admission age greater than 12 months (OR = 2.44, 95 CI [1.59 3.88]) and presence of subarachnoid hemorrhage (OR = 1.84, 95 CI [1.28 2.71]) were significant (p < 0.01) independent risk factors for prophylactic AED administration.
Conclusion : We concluded that hospital admission age greater than 12 months and the presence of subarachnoid hemorrhage are significant positive independent risk factors for the administration of prophylactic AEDs, while race, ethnicity, sex, and non-accidental trauma were not; this suggests that some patient characteristics have a greater impact on the decision to administer prophylactic AEDs than others. Larger, multi-center studies are warranted to understand if prophylactic AEDs can alter disease course at-risk pediatric TBI populations.
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