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EEG Monitoring and Antiepileptic Drugs in Children with Severe TBI

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Abstract

Background

Traumatic brain injury (TBI) causes substantial morbidity and mortality in US children. Post-traumatic seizures (PTS) occur in 11–42% of children with severe TBI and are associated with unfavorable outcome. Electroencephalographic (EEG) monitoring may be used to detect PTS and antiepileptic drugs (AEDs) may be used to treat PTS, but national rates of EEG and AED use are not known. The purpose of this study was to describe the frequency and timing of EEG and AED use in children hospitalized after severe TBI.

Methods

Retrospective cohort study of 2165 children at 30 hospitals in a probabilistically linked dataset from the National Trauma Data Bank (NTDB) and the Pediatric Health Information Systems (PHIS) database, 2007–2010. We included children (age <18 years old at admission) with linked NTDB and PHIS records, severe (Emergency Department [ED] Glasgow Coma Scale [GCS] <8) TBI, hospital length of stay >24 h, and non-missing disposition. The primary outcomes were EEG and AED use.

Results

Overall, 31.8% of the cohort had EEG monitoring. Of those, 21.8% were monitored on the first hospital day. The median duration of EEG monitoring was 2.0 (IQR 1.0, 4.0) days. AEDs were prescribed to 52.0% of the cohort, of whom 61.8% received an AED on the first hospital day. The median duration of AED use was 8.0 (IQR 4.0, 17.0) days. EEG monitoring and AED use were more frequent in children with known risk factors for PTS. EEG monitoring and AED use were not related to hospital TBI volume.

Conclusion

EEG use is relatively uncommon in children with severe TBI, but AEDs are frequently prescribed. EEG monitoring and AED use are more common in children with known risk factors for PTS.

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Acknowledgements

This work was supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development at the National Institutes of Health (Grant K23HD074620 to TB).

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Authors and Affiliations

  1. Pediatric Critical Care, Children’s Hospital Colorado, University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 300, Campus Mail F443, Aurora, CO, 80045, USA

    Christopher M. Ruzas, Kimberly S. Bennett & Tellen D. Bennett

  2. Bioinformatics and Biostatistics, Colorado School of Public Health, Aurora, CO, USA

    Peter E. DeWitt

  3. Pediatric Neurology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA

    Kevin E. Chapman

  4. Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA

    Nicole Harlaar

  5. Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA

    Tellen D. Bennett

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  1. Christopher M. Ruzas
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Correspondence to Tellen D. Bennett.

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Ruzas, C.M., DeWitt, P.E., Bennett, K.S. et al. EEG Monitoring and Antiepileptic Drugs in Children with Severe TBI. Neurocrit Care 26, 256–266 (2017). https://doi.org/10.1007/s12028-016-0329-8

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