University of Utah School of Medicine & Primary Children's Medical Center Department of Pediatrics, Division of Critical Care Medicine, Salt Lake City, Utah 84118, USA.
J Neurotrauma. 2011 May;28(5):755-62. doi: 10.1089/neu.2010.1518. Epub 2011 Apr 21.
We performed a retrospective, observational study at a level I pediatric trauma center of children with moderate-to-severe traumatic brain injury (TBI) from January 2002 to September 2006 to identify clinical and radiographic risk factors for early post-traumatic seizures (EPTS). Two hundred and ninety-nine children ages 0-15 years were evaluated, with 24 excluded because they died before the initial head computed tomography (CT) was obtained (n=20), or because their medical records were missing (n=4). Records were reviewed for accident characteristics, pre-hospital hypoxia or hypotension, initial non-contrast head CT characteristics, seizure occurrence, antiepileptic drug (AED) administration, and outcome. All care was at the discretion of the treating physicians, including the use of AEDs and continuous electroencephalogram (EEG) monitoring in patients receiving neuromuscular blocking agents. The primary outcome was seizure activity during the first 7 days as determined by clinician observation or EEG analysis. Of the 275 patients included in the study, 34 had identified EPTS (12%). Risk factors identified on bivariable analysis included pre-hospital hypoxia, young age, non-accidental trauma (NAT), severe TBI, impact seizure, and subdural hemorrhage, while receiving an AED was protective. Independent risk factors identified by multivariable analysis were age <2 years (OR 3.0 [95% CI 1.0,8.6]), Glasgow Coma Scale (GCS) score ≤8 (OR 8.7 [95% CI 1.1,67.6]), and NAT as a mechanism of injury (OR 3.4 [95% CI 1.0,11.3]). AED treatment was protective against EPTS (OR 0.2 [95% CI 0.07,0.5]). Twenty-three (68%) patients developed EPTS within the first 12 h post-injury. This early peak in EPTS activity and demonstrated protective effect of AED administration in this cohort suggests that to evaluate the maximal potential benefit among patients at increased risk for EPTS, future research should be randomized and prospective, and should intervene during pre-trauma center care with initiation of continuous EEG monitoring as soon as possible.
我们在一家一级儿科创伤中心进行了一项回顾性观察研究，研究对象为 2002 年 1 月至 2006 年 9 月期间患有中重度创伤性脑损伤（TBI）的儿童，旨在确定早期创伤后癫痫发作（EPTS）的临床和影像学危险因素。共有 299 名 0-15 岁的儿童接受了评估，其中 24 名因在获得初始头部计算机断层扫描（CT）之前死亡（n=20）或病历缺失（n=4）而被排除在外。记录了事故特征、院前低氧血症或低血压、初始非对比头部 CT 特征、癫痫发作、抗癫痫药物（AED）的使用以及结局。所有治疗均由主治医生决定，包括在接受神经肌肉阻滞剂的患者中使用 AED 和连续脑电图（EEG）监测。主要结局是通过临床医生观察或 EEG 分析确定的 7 天内的发作活动。在研究中纳入的 275 名患者中，有 34 名患者发生了 EPTS（12%）。单变量分析确定的危险因素包括院前低氧血症、年龄较小、非意外创伤（NAT）、严重 TBI、撞击性癫痫发作和硬膜下血肿，而使用 AED 具有保护作用。多变量分析确定的独立危险因素包括年龄<2 岁（OR 3.0[95%CI 1.0，8.6]）、格拉斯哥昏迷量表（GCS）评分≤8（OR 8.7[95%CI 1.1，67.6]）和作为损伤机制的 NAT（OR 3.4[95%CI 1.0，11.3]）。AED 治疗对 EPTS 具有保护作用（OR 0.2[95%CI 0.07，0.5]）。23 名（68%）患者在受伤后 12 小时内出现 EPTS。本研究中 EPTS 活动的早期高峰以及 AED 治疗的保护作用表明，为了评估 EPTS 风险增加的患者的最大潜在益处，未来的研究应该是随机的、前瞻性的，并且应该在创伤中心治疗前开始，尽快启动连续 EEG 监测。
