title: Anti-seizure prophylaxis in critically ill patients with traumatic brain injury in an intensive care unit.
abstract: The objectives of this prospective observational study were to determine the proportion of patients with traumatic brain injury who received effective anti-seizure prophylaxis. The study was conducted in a tertiary level ICU of a major trauma referral centre between February 2012 and August 2013. A total of 2361 patients were admitted to the ICU in this study period, of whom125 patients (index) with traumatic head injury were included in this study. The patients had a mean age of 45 years (SD=19), a mean score on the Glasgow Coma Scale of 9 (SD=4), a mean injury severity score of 27 (SD=13) and a mean APACHE III score of 55 (SD=27). Only 13.6 % (17 of 125) of patients were given anti-seizure prophylaxis and phenytoin levels were measured in 9.6% (12 of 125). Although all 12 patients achieved an effective concentration for phenytoin therapy (>40 µmol/l) after the loading dose, no patient had their target concentration consistently maintained in the recommended therapeutic range (40 to 80 µmol/l) throughout the seven-day monitoring period. There was wide fluctuation in phenytoin levels in the patients in this study. Twenty-two (18%) of the index patients had post-traumatic seizures, indicating a high prevalence for this study. Poor compliance with guidelines could possibly explain this phenomenon. Future studies are needed to look at the dosing and monitoring of phenytoin and/or alternative anti-seizure prophylaxis in patients with traumatic brain injury.
authors: Staff Specialist, Intensive Care Unit, Royal Adelaide Hospital and Senior Clinical Lecturer, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia.
authors: K
authors: K
authors: Sundararajan
authors: Senior Pharmacist, Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia.
authors: D
authors: D
authors: Milne
authors: Statistician, Data Management and Analysis Centre (DMAC), Discipline of Public Health, University of Adelaide, Adelaide, South Australia.
authors: S
authors: S
authors: Edwards
authors: Director of ICU Research and Senior Staff Specialist, Intensive Care Unit, Royal Adelaide Hospital and Professor, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia.
authors: M J
authors: MJ
authors: Chapman
authors: Director, Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia.
authors: S
authors: S
authors: Shakib
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000097:blood / Q000627:therapeutic use*; D012640:Seizures / Q000517:prevention & control*
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin
keywords: intensive care unit; phenytoin; post-traumatic seizures; traumatic brain injury