Abstract | INTRODUCTION: METHODS: All trauma patients sustaining a TBI from January 2007 to December 2009 at an urban level-one trauma center were retrospectively analyzed. Seizures were identified from a prospectively gathered morbidity database and anticonvulsant use from the pharmacy database. Statistical comparisons were made by Chi square, t tests, and logistic regression modeling. Patients who received levetiracetam prophylaxis were matched 1:1 using propensity score matching with those who did not receive the drug. RESULTS: 5551 trauma patients suffered a TBI during the study period, with an overall seizure rate of 0.7 % (39/5551). Of the total population, 1795 were diagnosed with severe TBI (Head AIS score 3-5). Seizures were 25 times more likely in the severe TBI group than in the non-severe group [2.0 % (36/1795) vs. 0.08 % (3/3756); OR 25.6; 95 % CI 7.8-83.2; p < 0.0001]. Of the patients who had seizures after severe TBI, 25 % (9/36) received pharmacologic prophylaxis with levetiracetam, phenytoin, or fosphenytoin. In a matched cohort by propensity scores, no difference was seen in seizure rates between the levetiracetam group and no-prophylaxis group (1.9 vs. 3.4 %, p = 0.50). CONCLUSIONS: In this propensity score-matched cohort analysis, levetiracetam prophylaxis was ineffective in preventing seizures as the rate of seizures was similar whether patients did or did not receive the drug. The incidence of post-traumatic seizures in severe TBI patients was only 2.0 % in this study; therefore we question the benefit of routine prophylactic anticonvulsant therapy in patients with TBI.
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Authors | Bardiya Zangbar, Mazhar Khalil, Angelika Gruessner, Bellal Joseph, Randall Friese, Narong Kulvatunyou, Julie Wynne, Rifat Latifi, Peter Rhee, Terence O'Keeffe |
Journal | World journal of surgery
(World J Surg)
Vol. 40
Issue 11
Pg. 2667-2672
(Nov 2016)
ISSN: 1432-2323 [Electronic] United States |
PMID | 27307089
(Publication Type: Journal Article)
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Chemical References |
- Anticonvulsants
- Levetiracetam
- Phenytoin
- fosphenytoin
- Piracetam
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Topics |
- Adolescent
- Adult
- Anticonvulsants
(therapeutic use)
- Brain Injuries, Traumatic
(complications)
- Chemoprevention
- Databases, Factual
- Female
- Humans
- Levetiracetam
- Male
- Middle Aged
- Phenytoin
(analogs & derivatives, therapeutic use)
- Piracetam
(analogs & derivatives, therapeutic use)
- Propensity Score
- Retrospective Studies
- Seizures
(etiology, prevention & control)
- Treatment Failure
- Young Adult
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