Short Attention Span Summary
Post-traumatic seizure – a marker of intracranial injury
This was a planned subanalysis of the PECARN head injury study. Of the >42,000 kids enrolled in the original study, 536 had post-traumatic seizure (PTS). Of the 466/536 who had a head CT, 72/466 (15.5%) had abnormalities on CT and 5/466 (1.1%) had recurrent seizures. The longer the time from impact to PTS and the longer the duration of PTS, the greater the chance of having an abnormal CT. See the PECARN rule.
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Pediatric patients with PTS need a head CT. Those with a normal head CT may be safely discharged and have very low risk of recurrent seizures. Become an expert on pediatric minor head injury in 10 minutes with this outstanding case presentation and in-depth discussion of minor pediatric head injury.
Abstract
Acad Emerg Med. 2017 Feb 7. doi: 10.1111/acem.13168. [Epub ahead of print]
Prevalence of Brain Injuries and Recurrence of Seizures in Children with Post Traumatic Seizures.
Badawy MK1, Dayan PS2, Tunik MG3, Nadel FM4, Lillis KA5, Miskin M6, Borgialli DA7, Bachman MC8, Atabaki SM9, Hoyle JD Jr10, Holmes JF11, Kuppermann N11,12; Pediatric Emergency Care Applied Research Network (PECARN).
Author information:
1Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas.
2Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
3Departments of Emergency Medicine and Pediatrics, NYU School of Medicine, New York, NY.
4Department of Pediatrics, University of Pennsylvania, School of Medicine, Philadelphia, PA.
5Departments of Pediatrics and Emergency Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
6Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, Salt Lake City, UT.
7Department of Emergency Medicine, University of Michigan School of Medicine and Hurley Medical Center, Flint, MI.
8Departments of Emergency Medicine and Pediatrics, Newark Beth Israel Medical Center, Newark, NJ.
9Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC.
10Division of Emergency Medicine, Michigan State University School of Medicine/Helen Devos Children’s Hospital, Grand Rapids, MI.
11Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA.
12Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA.
Abstract
OBJECTIVES:
Computed tomography (CT) is often used in the emergency department (ED) evaluation of children with post-traumatic seizures (PTS); however, the frequency of traumatic brain injuries (TBI) and short-term seizure recurrence is lacking. Our main objective was to evaluate the frequency of TBI on CT and short-term seizure recurrence in children with PTS. We also aimed to determine the associations between the likelihood of TBI on CT with the timing of onset of PTS after the traumatic event and duration of PTS. Finally, we aimed to determine whether patients with normal CT scans and normal neurological examinations are safe for discharge from the ED.
METHODS:
This was a planned secondary analysis from a prospective observational cohort study to derive and validate a neuroimaging decision rule for children after blunt head trauma at 25 emergency departments (ED) in the Pediatric Emergency Care Applied Research Network (PECARN). We evaluated children <18 years with head trauma and PTS between June 2004 and September 2006. We assessed TBI on CT, neurosurgical interventions and recurrent seizures within one week. Patients discharged from the ED were contacted by telephone 1 week-3 months later.
RESULTS:
Of 42,424 children enrolled, 536 (1.3%, 95% CI 1.2, 1.4%) had PTS. 466 of 536 (86.9%, 95% CI 83.8, 89.7%) underwent CT in the ED. TBIs on CT were identified in 72 (15.5%, 95% CI 12.3, 19.1%), of whom 20 (27.8%, 95% CI 17.9, 39.6%) underwent neurosurgical intervention, and 15 (20.8%, 95% CI 12.2, 32.0%) had recurrent seizures. Of the 464 without TBIs on CT (or no CTs performed), 457 had recurrent seizure status known, and 5 (1.1%, 95 CI 0.4, 2.5%) had recurrent seizures; 4 of 5 presented with GCS scores <15. None of the 464 underwent neurosurgical intervention. We found significant associations between likelihood of TBI on CT with longer time until the PTS after the traumatic event (p=0.006) and longer duration of PTS (p<0.001).
CONCLUSIONS:
Children with PTS have a high likelihood of TBI on CT, and those with TBI on CT frequently require neurosurgical interventions and frequently have recurrent seizures. Those without TBI on CT, however, are at low risk of short-term recurrent seizures, and none required neurosurgical interventions. Therefore, if CT-negative and neurologically normal, patients with PTS may be safely considered for discharge from the ED. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
PMID: 28170143 [PubMed – as supplied by publisher]
what percentage of the kids with PTS and had TBI would have been missed by the PECARN rules as is?
0% for those with PTS and all 6 PECARN criteria negative. And 1 child had PTS and all 6 PECARN criteria for kids >2 negative. He had pneumocephalus and was discharged from the ED. But there were only 51 kids in this category.