Early Post-Traumatic Seizures in Moderate to Severe Pediatric Traumatic Brain Injury: Rates, Risk Factors, and Clinical Features
Early Post-Traumatic Seizures in Moderate to Severe Pediatric Traumatic Brain Injury: Rates, Risk Factors, and Clinical Features
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DOI：
10.1089/neu.2010.1518
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Statler, Kimberly D.
中科院分区：
文献类型：
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作者：
Liesemer, Kate;Bratton, Susan L.;Statler, Kimberly D.
我们在 2002 年 1 月至 2006 年 9 月期间在儿童一级创伤中心对患有中度至重度创伤性脑损伤 (TBI) 的儿童进行了一项回顾性观察性研究，以确定早期创伤后癫痫发作 (EPTS) 的临床和影像学危险因素。对 299 名 0-15 岁的儿童进行了评估，其中 24 名儿童被排除在外，因为他们在获得最初的头部计算机断层扫描 (CT) 之前死亡 (n=20)，或者因为他们的医疗记录丢失 (n=4)。审查了事故特征、院前缺氧或低血压、初始非对比头部 CT 特征、癫痫发作、抗癫痫药物 (AED) 给药和结果等记录。所有护理均由治疗医生酌情决定，包括对接受神经肌肉阻滞剂的患者使用 AED 和连续脑电图 (EEG) 监测。主要结果是通过临床医生观察或脑电图分析确定的前 7 天内的癫痫发作活动。在该研究纳入的 275 名患者中，34 名患者确诊为 EPTS（12%）。双变量分析确定的危险因素包括院前缺氧、年轻、非意外创伤 (NAT)、严重 TBI、冲击性癫痫发作和硬膜下出血，而接受 AED 具有保护作用。通过多变量分析确定的独立危险因素是年龄
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, nonaccidental trauma (NAT), severe TBI, impact seizure, and subdural hemorrhage, while receiving an AED was protective. Independent risk factors identified by multivariable analysis were age