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J Pediatr Intensive Care 2024; 13(04): 364-371
DOI: 10.1055/s-0042-1743500
Original Article

Associations between Electroencephalographic Variables, Early Post-Traumatic Seizure Risk, and Outcomes following Pediatric Severe Traumatic Brain Injury

Taylor E. Nickerson 
1   Division of Critical Care Medicine, Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, United States
,
Lauren Villo
2   Division of Critical Care Medicine, Department of Pediatrics, Atrium Health Navicent, Mercer University, Macon, Georgia, United States
,
Mariah Eisner
3   Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, United States
,
Marlina E. Lovett
4   Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Melissa G. Chung
4   Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio, United States
5   Division of Neurology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Nicole F. O'Brien
4   Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Eric A. Sribnick
6   Division of Neurological Surgery, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Adam P. Ostendorf
5   Division of Neurology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio, United States
› Author Affiliations Funding None.
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Abstract

Early post-traumatic seizures (PTS) are associated with worse outcomes in children with traumatic brain injury (TBI). Our aim was to identify the association between continuous electroencephalogram (cEEG) characteristics and early PTS risk following pediatric severe TBI. We also evaluated the relationship between cEEG background features and outcomes. A single-center retrospective cohort study was performed on children between 0 and 18 years of age admitted to the pediatric intensive care unit from 2016 to 2019 with severe TBI and cEEG monitoring within 7 days of injury. Raw cEEG tracings were reviewed by an epileptologist in accordance with American Clinical Neurophysiology Society (ACNS) Critical Care EEG terminology. Univariate comparisons were made between children with and without early PTS, as well as between those with and without varying cEEG background features. Eighteen children (31%) of the 59 included had early PTS. Interictal abnormalities, inclusive of sporadic spikes and sharp waves, rhythmic delta activity, or lateralized periodic discharges (LPDs) were more common among children with seizures (100 vs. 22%; p < 0.01). LPDs were also more common in the seizure group (44 vs. 2%; p < 0.01). Background discontinuity was associated with worse Glasgow Outcome Scale—Extended Pediatric Version (GOS-E Peds) scores at discharge and 3-, 6-, and 12-month post-discharge (p < 0.01). Lack of reactivity was also associated with worse GOS-E Peds scores at 3-, 6-, and 12-month post-discharge (p < 0.01). Interictal abnormalities and LPDs were each associated with early PTS following pediatric severe TBI. Larger studies should evaluate if high-risk patients would benefit from prolonged cEEG monitoring and/or more aggressive anti-seizure prophylaxis. Discontinuity and lack of variability were associated with worse outcomes. Future studies should attempt to clarify their role as potential early markers of prognosis.

Keywords

electroencephalography - severe TBI - pediatrics - post-traumatic seizures - outcome


Publication History

Received: 17 September 2021

Accepted: 26 January 2022

Article published online:
28 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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