title: Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following traumatic brain injury.
abstract: Posttraumatic seizures (PTS) are well-recognized acute and chronic complications of traumatic brain injury (TBI). Risk factors have been identified, but considerable variability in who develops PTS remains. Existing PTS prognostic models are not widely adopted for clinical use and do not reflect current trends in injury, diagnosis, or care. We aimed to develop and internally validate preliminary prognostic regression models to predict PTS during acute care hospitalization, and at year 1 and year 2 postinjury.
  
  
  
  Prognostic models predicting PTS during acute care hospitalization and year 1 and year 2 post-injury were developed using a recent (2011-2014) cohort from the TBI Model Systems National Database. Potential PTS predictors were selected based on previous literature and biologic plausibility. Bivariable logistic regression identified variables with a p-value < 0.20 that were used to fit initial prognostic models. Multivariable logistic regression modeling with backward-stepwise elimination was used to determine reduced prognostic models and to internally validate using 1,000 bootstrap samples. Fit statistics were calculated, correcting for overfitting (optimism).
  
  
  
  The prognostic models identified sex, craniotomy, contusion load, and pre-injury limitation in learning/remembering/concentrating as significant PTS predictors during acute hospitalization. Significant predictors of PTS at year 1 were subdural hematoma (SDH), contusion load, craniotomy, craniectomy, seizure during acute hospitalization, duration of posttraumatic amnesia, preinjury mental health treatment/psychiatric hospitalization, and preinjury incarceration. Year 2 significant predictors were similar to those of year 1: SDH, intraparenchymal fragment, craniotomy, craniectomy, seizure during acute hospitalization, and preinjury incarceration. Corrected concordance (C) statistics were 0.599, 0.747, and 0.716 for acute hospitalization, year 1, and year 2 models, respectively.
  
  
  
  The prognostic model for PTS during acute hospitalization did not discriminate well. Year 1 and year 2 models showed fair to good predictive validity for PTS. Cranial surgery, although medically necessary, requires ongoing research regarding potential benefits of increased monitoring for signs of epileptogenesis, PTS prophylaxis, and/or rehabilitation/social support. Future studies should externally validate models and determine clinical utility.
authors.affiliation: Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Ritter
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.|Center for Neuroscience at University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Wagner
authors.affiliation: Department of Neurology, University of Alabama at Birmingham Epilepsy Center, University of Alabama, Birmingham, Alabama, U.S.A.
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.affiliation: Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Brooks
authors.affiliation: Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
authors.affiliation: South Texas Veterans Health Care System Polytrauma Rehabilitation Center, San Antonio, Texas, U.S.A.|Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A.
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
authors.affiliation: Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: Carolinas Rehabilitation, Charlotte, North Carolina, U.S.A.|Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Departments of Physical Medicine and Rehabilitation and Ophthalmology, University of Alabama, Birmingham, Alabama, U.S.A.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dreer
authors.affiliation: Rusk Rehabilitation, New York University School of Medicine, New York, New York, U.S.A.
authors.forename: Tamara
authors.initials: T
authors.lastname: Bushnik
authors.affiliation: Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, U.S.A.
authors.forename: William C
authors.initials: WC
authors.lastname: Walker
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Brown
authors.affiliation: Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Doug
authors.initials: D
authors.lastname: Johnson-Greene
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Timothy
authors.initials: T
authors.lastname: Shea
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Krellman
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000628:therapy*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology*; D013997:Time Factors; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Craniectomy; Epilepsy; Prognostic modeling; Risk factors; TBI Model System