Research Reports - Prevalence and risk factors for early seizure in patients with traumatic brain injury

Neurocrit Care. 2017 Aug;27(1):90-95. doi: 10.1007/s12028-016-0363-6.

Majidi S(1), Makke Y(2), Ewida A(2), Sianati B(2), Qureshi AI(3), Koubeissi
MZ(2).

BACKGROUND: Traumatic brain injury (TBI) is a well-known risk factor for
seizures. We aimed to identify the frequency and risk factors for seizure
occurrence during hospitalization for TBI.
METHODS: We used ICD-9-CM codes to identify patients 18 years of age or older
from the National Trauma Data Bank who were admitted with TBI. We also used
ICD-9-CM codes to identify the subset who had seizures during hospitalization.
Patient demographics, comorbidities, Glasgow Coma Scale (GCS) score, Injury
Severity Score Abbreviated Injury Scale (ISSAIS), in-hospital complications, and
discharge disposition were compared in the seizure group (SG) and no-seizure
group (NSG).
RESULTS: A total of 1559 patients had in-hospital seizures, comprising 0.4% of
all patients admitted with TBI. The mean age of SG was 3 years older than NSG [51
vs. 48; p < 0.0001]. African-American ethnicity (20 vs. 12%, p < 0.0001) and
moderate TBI (8 vs. 4%, p < 0.0001) were more common in SG. History of alcohol
dependence was more common in the SG (25 vs. 11%, p < 0.0001). Fall was the most
common mechanism of injury in SG (56 vs. 36% in NSG; p < 0.0001). Subdural
hematoma was more common in SG (31 vs. 21%, p < 0.0001). SG had higher rates of
pneumonia, ARDS, acute kidney injury, and increased ICP. The average length of
hospital stay was significantly higher in SG (10 vs. 6 days, p < 0.0001), and
these patients had higher rate of discharge to nursing facility (32 vs. 25%,
p < 0.0001).
CONCLUSION: In-hospital seizures occur in 0.4% of all TBI patients. Although
infrequent, seizure occurrence is associated with higher rates of hospital
complications such as pneumonia and ARDS and is an independent predictor of
longer hospital stay and worse hospital outcome. 

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