Clinical predictors of post-traumatic seizures in children with head trauma.
OBJECTIVE
To determine the clinical characteristics associated with early post-traumatic seizures in children with head trauma. DESIGN, SETTING, AND TYPE OF PARTICIPANTS: Retrospective chart review; urban trauma center/pediatric emergency department. Trauma patients aged 3 months to 15 years given discharge diagnosis ICD-9-CM codes indicating head trauma and seen from 1988 to 1990 were eligible for the study.


METHODS
None.


RESULTS
Of 194 patients, 96% suffered blunt trauma and 53% had a loss of consciousness. Fifty-one percent of 141 computed tomography (CT) scans of the head were abnormal, most frequently demonstrating skull fractures (34%), subdural hematomas (15%), and cerebral contusions (14%). Eighteen patients (9.3%) suffered post-traumatic seizures. A loss of consciousness, a low Glasgow Coma Scale (GCS) score (3 to 8), and an abnormal CT scan were associated with post-traumatic seizures (P < .02, .001, and .02, respectively). However, only a low GCS score was predictive of post-traumatic seizures when these factors were considered simultaneously (P < .001), with 38.7% of patients with low GCS scores suffering post-traumatic seizures and 3.8% of patients with high GCS scores suffering post-traumatic seizures. In children with low GCS scores, treatment with phenytoin was associated with a decrease in post-traumatic seizures.


CONCLUSIONS
In the pediatric head trauma patient, a GCS score of 3 to 8 appears to be predictive of post-traumatic seizures. The data from this retrospective study are consistent with the hypothesis that prophylactic phenytoin reduces post-traumatic seizures in the pediatric head trauma patient with a low GCS score.
Lewis
R J
RJ
Department of Emergency Medicine, University of California, Los Angeles School of Medicine, Harbor-UCLA Medical Center, Torrance.
Yee
L
L
Inkelis
S H
SH
Gilmore
D
D
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D015600:Glasgow Coma Scale; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010672:Phenytoin / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology* / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014474:Unconsciousness
D010672:Phenytoin