Abstracts

Rationale: Traumatic Brain Injury (TBI) is the #1 cause of death and disability in the pediatric population. Early post-traumatic seizure (EPTS; seizure <7 days post-injury) is a frequent complication of pediatric moderate-severe TBI. The significance of continuous EEG (cEEG) monitoring has been shown in adult moderate-severe TBI, however, reports on cEEG in pediatric moderate-severe TBI are lacking. Methods: 2 primary objectives were identified: (1) Define EPTS incidence/types in pediatric moderate-severe TBI relative to published adult rates; and (2) Determine if EPTS influence short-term outcome. We hypothesized that (1) children would have a higher rate of EPTS, electrographic-only EPTS, and epileptiform discharges (non-seizure group); and (2) EPTS negatively impact short-term outcome with longer ICU/hospital length of stay (LOS) and intubation, and worse global outcome. 27 patients with moderate-severe TBI consecutively admitted over 9 months, who received institution-wide TBI-specific cEEG protocol reviewed by epileptologists, were consented and enrolled; only 1 patient was ineligible (no cEEG). 25 gold electrodes were placed by the International 10-20 system. Seizures were typed as clinical (clinically apparent signs during electrographic seizure), subtle clinical (clinical signs only detectable on careful video review of EEG-detected seizure), and electrographic (no clinical signs); subclinical includes both subtle clinical and electrographic types. KOSCHI outcomes were dichotomized (Good = 4-5, Bad = 1-3). Chi square, t-tests, and logistic regression analyses were used. Results: See table 1 for data summary and comparison with adults (Vespa et al. 99), by /- EPTS groups, and by mechanism of injury (M.O.I.). Figure 1 outlines time to first EPTS and EPTS incidence by M.O.I. EPTS rate (both prior to and during cEEG) was 2.5-fold higher than adult rate (55.5% vs 22.3%; p=0.03), and even higher in nonaccidental trauma (NAT, 84.6%, p=0.01). 10/15 with EPTS (67%), or 10/27 (37%) total patients recorded, had subclinical seizures detected only by cEEG (mostly electrographic-only). Electrographic-only EPTS rate (no clinical signs, 3/27, 11.1%) was similar to adults (11.7%; p>0.99). Epileptiform discharge rate (non-seizure group) was 5-fold higher than adults (50% vs 10%; p=0.02). Status epilepticus occurred <7 days post-injury in 12/27 (44.4%), and was often subclinical (8/12, 67%). EPTS risk was significantly increased with both NAT (RR 2.96, p=0.007) and age <2yo (RR 3.7, p=0.003). NAT risk remained significant after adjustment for post-injury hypotension/hypoxia (RR 2.94, p=0.01). Conclusions: Children had significantly higher EPTS and epileptiform discharge rates than adults. Children have high rates of subclinical EPTS and status epilepticus detected only by cEEG. EPTS rates were significantly higher and occurred earlier in NAT children. Age <2yo was also a predictor of EPTS, and it is unclear if mechanism of injury or younger age, or both, were critical factors. EPTS did not influence any short-term outcome measures.