Early EEG to Predict Severity of Injury in Infants with Abusive Traumatic Brain Injury
Abstract number :
1.232
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2022
Submission ID :
2204462
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Natasha Varughese, MD – UT Southwestern; Ali Hasan, MD – Fellow Physician, Pediatrics, Division of Intensive Care, UT Southwestern; Naomi Cohen, BS – Medical Student, UT Southwestern; Deja Eaton, MPH – Data Scientist, Children's Medical Center Dallas; Rebekah Clarke, MD – Faculty, Radiology, UT Southwestern; Darryl Miles, MD – Faculty, Pediatrics, Division of Intensive Care, UT Southwestern; Lakshmi Raman, MD – Faculty, Pediatrics, Division of Intensive Care, UT Southwestern; Rana Said, MD, FAAN – Faculty, Neurology, Division of Child Neurology, UT Southwestern; Deepa Sirsi, MD – Faculty, Neurology, Division of Child Neurology, UT Southwestern
Rationale: Infants with abusive head injury comprise an understudied subset of pediatric TBI with worse outcomes than equivalent patients with accidental injuries. The implications of EEG findings (both seizure burden and severity of interictal background) on patient prognosis have not been well quantified.
Methods: A retrospective chart review was conducted at a pediatric Level 1 trauma center. The cohort included children < 1 year of age hospitalized with abusive TBI between 2015-2020 and followed outpatient by a child abuse specialist. Each of these patients was assigned a severity score for EEG background, MRI abnormalities, and motor and sensory neurologic outcome. Seizure burden metrics (presence of electrographic status epilepticus, maximum seizure burden per hour >20%, and total seizure burden time) were calculated by reviewing all raw EEGs. All scoring systems were previously published and validated for this age group (1-6). Spearman rank correlation was then used to assess the correlation coefficient.
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References:
1. Fox J, et al. EEG is A Predictor of Neuroimaging Abnormalities in Pediatric Extracorporeal Membrane Oxygenation. J Clin Med. 2020 Aug 4;9(8):2512.
2. Tharp B.R., Laboyrie P.M. The incidence of EEG abnormalities and outcome of infants paralyzed with neuromuscular blocking agents. Crit. Care Med. 1983;11:926-929.
3. Khan NR, et al. Pediatric abusive head trauma and stroke. J Neurosurg Pediatr. 2017 Aug;20(2):183-190.
4. Boop S. et al. Abusive head trauma: an epidemiological and cost analysis. J Neurosurg Pediatr. 2016 Nov;18(5):542-549.
5. Pollack MM, et al. Functional Status Scale: new pediatric outcome measure. Pediatrics. 2009 Jul;124(1):e18-28.
6. Payne ET, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014 May;137(Pt 5):1429-1438.
Results: Out of 161 children with abusive head trauma, 66 had EEG during the initial hospitalization, including 25 with seizures. Clinic follow-up was obtained in 51 of those patients at 1-6 months and 46 at 7-12 months post-trauma. Ages ranged from 0.5 to 11 months, mean weight was 6 ± 2 kg, and 16 were born prematurely. The patients with EEG tended to have greater injury than those without, as shown by longer hospitalizations and greater need for ICU interventions. Significant positive correlations were discovered between background EEG scores and MRI scores (0.338, p = 0.011) as well as motor outcome at 1-6 mo (0.332, p = 0.017) and 7-12 months (0.386, p = 0.08). Seizure burden metrics and sensory functional scores showed positive but insignificant correlations, possibly due to insufficient power in these data.
Conclusions: In infants with abusive TBI, EEG may be useful as an early marker of prognosis. More severe background EEG scores correlated with worse MRI scores and neurologic outcomes during their first year post-trauma. However, a larger prospective study would be required to validate this and to demonstrate a significant correlation between seizure burden metrics and these outcomes.
Funding: None
Clinical Epilepsy