Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital & University of Helsinki, Helsinki, Finland.
Department of Emergency Care and Services, Helsinki University Hospital & University of Helsinki, Helsinki, Finland.
Epilepsia. 2020 Apr;61(4):693-701. doi: 10.1111/epi.16483. Epub 2020 Mar 28.
Posttraumatic epilepsy (PTE) is a well-described complication of traumatic brain injury (TBI). The majority of the available data regarding PTE stem from the adult population. Our aim was to identify the clinical and radiological risk factors associated with PTE in a pediatric TBI population treated in an intensive care unit (ICU).
We used the Finnish Intensive Care Consortium database to identify pediatric (<18 years) TBI patients treated in four academic university hospital ICUs in Finland between 2003 and 2013. Our primary outcome was the development of PTE, defined as the need for oral antiepileptic medication in patients alive at 6 months. We assessed the risk factors associated with PTE using multivariable logistic regression modeling.
Of the 290 patients included in the study, 59 (20%) developed PTE. Median age was 15 years (interquartile range [IQR] 13-17), and 80% had an admission Glasgow Coma Scale (GCS) score ≤12. Major risk factors for developing PTE were age (adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00-1.16), obliterated suprasellar cisterns (OR 6.53, 95% CI 1.95-21.81), and an admission GCS score of 9-12 in comparison to a GCS score of 13-15 (OR 2.88, 95% CI 1.24-6.69).
We showed that PTE is a common long-term complication after ICU-treated pediatric TBI. Higher age, moderate injury severity, obliterated suprasellar cisterns, seizures during ICU stay, and surgical treatment are associated with an increased risk of PTE. Further studies are needed to identify strategies to decrease the risk of PTE.
创伤性脑损伤（TBI）后癫痫（PTE）是一种众所周知的并发症。关于 PTE 的大部分现有数据均来自成年人。我们的目的是在接受重症监护病房（ICU）治疗的儿科 TBI 人群中，确定与 PTE 相关的临床和影像学危险因素。
我们使用芬兰重症监护联合会数据库，确定了 2003 年至 2013 年期间在芬兰四所学术大学医院 ICU 接受治疗的儿科（<18 岁）TBI 患者。我们的主要结局是发生 PTE，定义为在 6 个月时存活的患者需要口服抗癫痫药物。我们使用多变量逻辑回归模型评估与 PTE 相关的危险因素。
在纳入研究的 290 名患者中，有 59 名（20%）发生了 PTE。中位年龄为 15 岁（四分位距 [IQR] 13-17），80%的患者入院格拉斯哥昏迷量表（GCS）评分≤12。发生 PTE 的主要危险因素是年龄（校正优势比 [OR] 1.08，95%置信区间 [CI] 1.00-1.16）、鞍上池闭塞（OR 6.53，95% CI 1.95-21.81）和入院 GCS 评分 9-12 与 GCS 评分 13-15 相比（OR 2.88，95% CI 1.24-6.69）。
我们表明，PTE 是 ICU 治疗的儿科 TBI 后常见的长期并发症。较高的年龄、中度损伤严重程度、鞍上池闭塞、ICU 期间发作和手术治疗与 PTE 风险增加相关。需要进一步研究以确定降低 PTE 风险的策略。
