Rethinking Seizure Care Blog

Pediatric Patients with Traumatic Brain Injuries in the ICU

Posted by RSC Diagnostics on May 19, 2020

Female doctor writing down her notes about little kids condition

Those who have had a traumatic brain injury are often at risk of posttraumatic epilepsy. This is a well-known fact, but most of the data are from adult patients rather than children. A recent study published in Epilepsia looked at how the TBI could affect pediatric patients. The researchers wanted to identify both clinical and radiological factors associated with posttraumatic epilepsy in pediatric patients with TBI who were treated in the ICU.

How Was the Study Conducted?

Several university hospitals participated in the study, including Helsinki University Hospital, the Finnish National Institute for Health and Welfare, and Statistics Finland. Researchers utilized data from the Finnish Intensive Care Consortium database.

Researchers identified patients who were less than 18 years old and who had a TBI. They looked at patients who were treated at four academic university hospital intensive care units between 2003 and 2013. They were essentially looking for patients who subsequently developed posttraumatic epilepsy. For this study, they defined this as the patient requiring oral antiepileptic and who were alive at six months post-injury.

The researchers used ICU data from the FICC database and reviewed the electronic health records and radiological images to confirm TBI with a blunt mechanism. Patients that did not have baseline data included were excluded from the study. Also, patients who had penetrating head injuries or who were missing follow-up data were excluded. The same was true of patients who had been using epilepsy medication prior to the TBI.

The functional outcome of the patients was accessed at six months based on the electronic health record data that was recorded. Patients that did not have any noticeable disability at this time were considered to have a favorable outcome. Those who passed away at some point during those six months were recorded and noted, as well.

What Were the Results?

The study included information from 315 patients. Out of that number, 25 of the patients died within six months. This reduced the overall study pool to 290 patients. The median follow-up time with the patients was 3.4 years. Out of those 290 patients, 59 of them developed posttraumatic epilepsy. The median time for purchasing an oral antiepileptic drug after the traumatic brain injury was 125 days.

Out of those patients with posttraumatic epilepsy, the researchers found that 81% of them had a favorable GOS (Glasgow Outcome Scale) after six months. 91% of patients who did not have posttraumatic epilepsy had a favorable GOS after this period. Research also showed that those patients who were slightly older had a higher risk of developing posttraumatic epilepsy than those who were younger.

The work done on this study helped to show that posttraumatic epilepsy is a "long-term complication after ICU-treated pediatric TBI." Factors such as "higher age, moderate injury severity, obliterated suprasellar cisterns, seizures during ICU stay, and surgical treatment" all could increase the risk of posttraumatic epilepsy. The researchers believe that further studies in this field can help to identify methods and strategies that could be used to reduce the risks for these patients.

Research like this in the field of epilepsy continues to be very important. There is still far less known about epilepsy than we would like, so further studies and research that can help to shed more light on the subject are helpful. The more research done with pediatric cases and adult cases, the better the outcome for future patients.

 


Sources:

https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16483?af=R

 

Topics: Pediatric Epilepsy