Abstract
Background
Electrographic seizures are frequent and associated with worse outcomes following traumatic brain injury (TBI). Despite this, the use of continuous electroencephalogram (cEEG) remains low. Our study describes cEEG usage and treatment dosing antiseizure medications (ASMs) in an international pediatric TBI population, hypothesizing that children monitored with cEEG have an increased rate of treatment ASMs because of electrographic seizure detection, compared with children who are not monitored with cEEG.
Methods
This subanalysis of the TBI cohort of the international PANGEA study included children, 7 days to 17 years of age, with acute neurological insults admitted to pediatric intensive care units. We analyzed demographics, injury severity, and therapies including prophylactic or treatment ASMs. We evaluated the relationships between cEEG use, seizure frequency, and receipt of treatment ASMs. \(\chi^{2}\) or Fisher’s exact test was used to analyze categorical variables, and the Kruskal–Wallis or Mann–Whitney U-test was used for continuous variables. Multivariable analysis for treatment ASM use was performed using logistic regression.
Results
One hundred-twenty-three of 174 patients with TBI were included. Twenty-seven patients (21.9%) underwent cEEG at any point during pediatric intensive care unit admission. Preexisting seizure disorder (18.2% vs. 2.3%, p = 0.014) and neuromuscular blockade use (52.4% vs. 24.1%, p = 0.011) were more frequently observed in the group monitored on cEEG when compared with those that were not. Presenting median Glasgow Coma Scale score was worse in the cEEG group (7 vs. 9, p = 0.044). There was no significant difference in age, use of intracranial pressure monitoring, or hyperosmolar therapy between the cEEG monitored and nonmonitored groups. Patients who were monitored on cEEG were more likely to receive a treatment dose ASM than those without cEEG monitoring (66.7% vs. 28.1%, p = 0.0002). When compared with those without treatment ASM, the treatment ASM group had more electrographic seizures on their first electroencephalogram following injury (51.6% vs. 4%, p = 0.0001) and more clinical seizures (55.8% vs. 0%, p < 0.0001).
Conclusions
Children monitored with cEEG after TBI have an increased prescription of treatment ASMs and clinical and electrographic seizures. The increased rate of treatment ASMs in the cEEG group may indicate increased recognition of electrographic seizures.
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Dr. Snooks conceptualized and designed the study, interpreted the data analysis, and drafted the initial article. Dr. Hanson, Dr. Farias-Moeller, and Dr. Fink participated in study design, data interpretation, and article revisions. Dr. Fink provided the data for the study. Dr. Yan conceived and provided statistical analysis of the data. Dr. Yan also reviewed and revised the article. All authors approved the final manuscript as submitted.
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Ericka L. Fink discloses that the PANGEA study was funded by a Laerdal Foundation Grant. The remaining authors have no disclosures.
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This work is adherent with ethical guidelines. The study details were submitted to Children’s Wisconsin Institutional Review Board and was deemed not Human Subjects Research. Submission of further institutional review board application was not required.
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Snooks, K.C., Yan, K., Farias-Moeller, R. et al. Continuous Electroencephalogram and Antiseizure Medication Use in an International Pediatric Traumatic Brain Injury Population. Neurocrit Care 36, 573–583 (2022). https://doi.org/10.1007/s12028-021-01337-7
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DOI: https://doi.org/10.1007/s12028-021-01337-7