(907) Seizure Prophylaxis in Young Children With Abusive Head Trauma or Accidental Traumatic Brain Injury

Tuesday, January 23, 2024

8:45 AM – 9:45 AM MT

Location: Connections Central - RST 17

First Author(s)

Caitlin McNamara, MD (she/her/hers)

Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania

Co-Author(s)

CM

Cesar Menchaca, MD

Physician
University of Pittsburgh, United States
TA

Taylor Abel, MD

Associate Professor, Chief of Pediatric Epilepsy Surgery
University of Pittsburgh, United States
RB

Rachel Berger, MD, MPH

Division Director, Child Advocacy and Professor of Pediatrics and Clinical and Translational Science
University of Pittsburgh, United States
EF

Ericka Fink, MD, FCCM

Professor of Critical Care Medicine and Pediatrics
Childrens Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States
Patrick M. Kochanek, MD, MCCM

Distinguished Professor of Critical Care Medicine
UPMC Presbyterian
Pittsburgh, Pennsylvania, United States
DS

Dennis Simon, MD

Assistant Professor of Critical Care Medicine, Director of Pediatric Neurocritical Care
Childrens Hospital of Pittsburgh of UPMC, United States

Introduction: Seizures occur frequently in young patients presenting with accidental traumatic brain injury (aTBI) and abusive head trauma (AHT). There are limited data on effectiveness of levetiracetam and fosphenytoin to prevent early post traumatic seizures in these patients.

Methods: We performed a retrospective cohort study of children < 3 years old admitted with AHT or accidental traumatic brain injury (aTBI) to the Pediatric Intensive Care Unit (PICU) at a Level 1 trauma center from 2011-2020. Our institutional guideline was for children with severe TBI to receive anti-epileptic drug (AED) prophylaxis. AEDs for mild or moderate TBI were used at the discretion of the treating physicians. Patient data were abstracted from the electronic health record. AHT was determined by the Child Protection Team; ‘highly concerning’ or ‘diagnostic’ injuries were included. Nonparametric tests were used to compare AED prophylaxis and TBI etiology.

Results: 457 patients (263 with AHT, 194 with aTBI) were included of whom 98(21%) received fosphenytoin, 102(22%) received levetiracetam, and 257(56%) did not receive AED prophylaxis. Children with AHT were more likely to receive AED prophylaxis (AHT 51% vs aTBI 35%; p=0.003). Children with AHT were more likely to have 1 seizure during hospitalization vs. children with aTBI: AHT 66/263[25%] vs aTBI 10/194[5%], p< 0.001. A difference in seizure frequency was observed between children that received fosphenytoin (35/98[36%]), levetiracetam (21/102[21%]), and no AED (20/257[8%]; p< 0.001). Multi-variable logistic regression controlling for mechanism and severity of injury (injury severity score (ISS), Glasgow Coma Score (GCS)) demonstrated that fosphenytoin (3.3 odds ratio [1.8,5.9 95% confidence interval]), and AHT (4.6[2.3,10.1]) were associated with seizure during admission. In the AHT patients, a multi-variable logistic regression controlling for severity of injury demonstrated that fosphenytoin (2.7[1.4,5.1]) was associated with seizure during admission.

Conclusions: In children < 3 years old with TBI admitted to our PICU, fosphenytoin prophylaxis had a higher risk of post-traumatic seizure than levetiracetam when controlling for mechanism and severity of injury. Our study suggests a possible advantage to the use of levetiracetam in AHT seizure prophylaxis.