Predictors of post-discharge seizures in children with traumatic brain injury

  • Andrew T. Hale
  • Kelly Pekala
  • Benjamin Theobald
  • Katherine Kelly
  • Michael Wolf
  • John C. Wellons
  • Truc Le
  • Chevis N. Shannon
Original Paper

Abstract

Purpose

In traumatic brain injury (TBI), hyperglycemia and hypothermia are thought to be associated with poor outcomes, but have not been systematically studied in children. Thus, our aim was to evaluate whether serum glucose and temperature at admission, among other clinical variables, were associated with need for post hospital-discharge seizure medication in children diagnosed with TBI.

Methods

We performed a retrospective study of 1814 children who were diagnosed with TBI at a tertiary pediatric hospital. Serum glucose levels at admission and temperature at initial presentation, 12, and 24 h were collected. Ongoing seizure activity was defined as discharge prescription of a seizure-modifying medication.

Results

We identified 121 patients with need for continued seizure medications, and 80 patients expired. Independent predictors of prolonged seizures included serum glucose levels above 140 mg/dl (p < 0.003) and 199 mg/dl (p < 0.001), hypothermia (<35 °C), subdural hematoma (p < 0.001), midline shift (p < 0.001), and > 1% temperature change in the first 24 h (p < 0.001). Multivariate regression adjusting for GCS revealed that bilateral bleed (p = 0.008), body-temperature instability (p = 0.026), subdural hematoma (p < 0.001), and mechanism of injury (p = 0.007) were predictive of prolonged seizure activity.

Conclusions

In summary, we conclude that body temperature may be playing a more significant role than glycemic control in propensity for ongoing seizure activity in children sustaining TBI.

Keywords

Traumatic brain injury Seizure Pediatric 

Notes

Acknowledgements

This research was supported in part by the Surgical Outcomes Center for Kids (SOCKs) at the Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Compliance with ethical standards

Conflicts of interest

The authors have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Andrew T. Hale
    • 1
    • 2
  • Kelly Pekala
    • 1
    • 2
  • Benjamin Theobald
    • 1
    • 2
  • Katherine Kelly
    • 1
  • Michael Wolf
    • 3
  • John C. Wellons
    • 1
    • 4
  • Truc Le
    • 3
    • 4
  • Chevis N. Shannon
    • 1
    • 4
  1. 1.Surgical Outcomes Center for KidsMonroe Carrell Jr. Children’s Hospital at Vanderbilt UniversityNashvilleUSA
  2. 2.Vanderbilt University School of MedicineNashvilleUSA
  3. 3.Department of PediatricsMonroe Carrell Jr. Children’s Hospital at Vanderbilt UniversityNashvilleUSA
  4. 4.Department of Neurological Surgery, Division of Pediatric NeurosurgeryVanderbilt University Medical CenterNashvilleUSA

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