Yachad N, Naidoo K D
Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.
Division of Critical Care, University of the Witwatersrand, Johannesburg, South Africa.
South Afr J Crit Care. 2022 May 6;38(1). doi: 10.7196/SAJCC.2022.v38i1.522. eCollection 2022.
Traumatic brain injury (TBI) is a common cause of paediatric intensive care unit (PICU) admissions in South Africa. Optimal care of these patients includes the prevention and control of post-traumatic seizures (PTS) in order to minimise secondary brain injury.
To describe the demographics of children admitted to a South African PICU, to describe the characteristics of PTS, and to describe the prophylactic and therapeutic management of PTS within the unit.
A 3-year retrospective chart review was conducted at the PICU of the Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg, from 1 July 2015 to 30 June 2018.
Seventy-eight patients were admitted to the PICU, all with severe TBI. A total of 66 patient files were available for analysis. The median age of admission was 6 years (interquartile range (IQR) 4 - 9) with the majority of trauma secondary to mechanical injury (89%). Prophylactic anti-epileptic drugs (AEDs) were initiated in 44 (79%) patients. Early PTS occurred in 11 (25%) patients who received prophylaxis and 4 (33%) who did not. Three (5%) patients developed late PTS, resulting in an overall incidence of PTS of 43%. The most common seizure type was generalised tonic clonic (82%). Children diagnosed with PTS were a median of 2 years younger than those without PTS, with increased prevalence of seizures (83% v. 38%) in children below 2 years of age. Maintenance therapy was initiated in all patients consistent with recommended dosages. Of the total 167 anti-epileptic levels taken during maintenance, only 56% were within target range. Of the initial 78 patients, 8 died (10%). The median length of stay was 7 (IQR 5 - 12) and 8 (IQR 8 - 24) days longer in ICU and hospital respectively, in children with PTS.
PTS is a frequent complication of severe TBI in children. There was considerable variation in the approach to both prophylaxis and maintenance therapy of PTS in terms of choice of agent, dosage, frequency of drug monitoring and approach to subtherapeutic levels. It is clear that more high-level studies are required in order to better inform these practices.
To the best of our knowledge, this article represents the first description of incidence and management practices of paediatric post traumatic seizures.
创伤性脑损伤（TBI）是南非儿科重症监护病房（PICU）收治患儿的常见原因。对这些患者的最佳护理包括预防和控制创伤后癫痫发作（PTS），以尽量减少继发性脑损伤。
描述入住南非PICU的儿童的人口统计学特征，描述PTS的特征，并描述该病房内PTS的预防性和治疗性管理。
对位于约翰内斯堡索韦托的克里斯·哈尼·巴拉干纳特学术医院（CHBAH）的PICU进行了一项为期3年的回顾性病历审查，时间跨度为2015年7月1日至2018年6月30日。
78名患者入住PICU，均为重度TBI。共有66份患者病历可供分析。入院时的中位年龄为6岁（四分位间距（IQR）4 - 9），大多数创伤继发于机械损伤（89%）。44名（79%）患者开始使用预防性抗癫痫药物（AED）。接受预防治疗的11名（25%）患者和未接受预防治疗的4名（33%）患者发生了早期PTS。3名（5%）患者发生了晚期PTS，导致PTS的总体发生率为43%。最常见的癫痫发作类型是全身强直阵挛发作（82%）。被诊断为PTS的儿童比未患PTS的儿童中位年龄小2岁，2岁以下儿童癫痫发作的患病率更高（83%对38%）。所有患者均按照推荐剂量开始维持治疗。在维持治疗期间采集的167次抗癫痫药物血药浓度中，只有56%在目标范围内。最初的78名患者中，8人死亡（10%）。PTS患儿在ICU和医院的中位住院时间分别比未患PTS的患儿长7天（IQR 5 - 12）和8天（IQR 8 - 24）。
PTS是儿童重度TBI的常见并发症。在PTS的预防和维持治疗方法上，无论是药物选择、剂量、药物监测频率还是亚治疗水平的处理方法，都存在很大差异。显然，需要更多的高水平研究来更好地指导这些实践。
据我们所知，本文首次描述了儿童创伤后癫痫发作的发病率和管理实践。
