Risk Factors of Hahn et al for Early Seizures in a Pediatric Patient After Traumatic Head Injury

Overview"

Hahn et al identified risk factors for early seizures occurring in a pediatric patient following head injury. These can help identify a patient who may benefit from closer monitoring and perhaps prophylactic therapy. The authors are from Children's Memorial Hospital and Northwestern University in Chicago, Illinois.

 

Early seizures usually occur during the first 24 hours after the head injury but may occur up to 7 days later.

 

Patient selection: <= 16 years of age

 

Exclusions: history of seizures, brain ischemia, hypoxia, and fluid-electrolyte imbalances

 

Parameters associated with early seizures after head injury:

(1) diffuse cerebral edema

(2) acute subdural hematoma

(3) compound and depressed skull fracture with cortical damage

(4) Glasgow coma scale (GCS)

Parameter	Finding	Points
diffuse cerebral edema	absent	0
	present	1
acute subdural hematoma	absent	0
	present	1
compound and depressed skull fracture with cortical damage	absent	0
	present	1
Glasgow coma score	9 - 15	0
	3 - 8	1

 

where:

• A Glasgow coma score <= 8 indicated severe head injury.

 

total number of risk factors =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 4

• The risk of post-traumatic seizures increases with the number of risk factors present.

• A pediatric patient with one or more risk factors may benefit from prophylactic therapy with an anticonvulsant.