Outcomes of early post traumatic seizures in head injury patients at Parirenyatwa hospital

Abstract

Primary Objective; To compare the outcome of Traumatic Brain Injury (TBI) patients who develop early post traumatic seizures with the outcome of patients with post traumatic seizures who do not develop early post traumatic seizures. Secondary Objectives; To estimate the incidence and risk factors of early post traumatic seizures in traumatic brain injured patients at Parirenyatwa Hospital. Study factors; Early post traumatic seizures were the main study factor. Other various clinical and radiological factors were also considered. Study outcomes; The Glasgow outcome score was used to assess outcome. Patients with a GOS of 1,2 or 3 were considered to have a poor outcome whereas patients with GOS of 4 or 5 were considered to have a good outcome. Subjects; 252 consecutive patients, regardless of age who were admitted at Parirenyatwa Hospital for traumatic brain injury from 01/10/2014 to 15/05/2015. Methods; A prospective observational study. A data sheet was created which listed all study and outcome factors. Statistics; Contingency tables and Chi-square statistics were used to compare the outcomes. Both univariate and multivariate analysis was carried out. Results; 252 patients have been recruited so far. 200 were males and 63 females. 31 patients developed early post traumatic seizures during the course of the study, giving an incidence of 12.3%. 35 patients died giving a case fatality rate of 13.8%. 52 patients (20.6%) had poor outcome. Of the patients who fitted, 64.5% had bad outcome compared to 14.5% of those who did not fit. The association between fits and poor outcome was found to be statistically significant. The relative risk of poor outcome on univariate analysis in patients with early post traumatic seizures was 10.7 (CI 4.7-24.5) with a p-value of 0.000. Factors which were statistically significantly associated with poor outcome on univariate analysis were; fits, low Glasgow coma scale, age, male sex, anisocoria, alcohol ingestion, retained foreign body, acute epidural haematoma, intracerebral haematoma, multiple cerebral contusions and subarachnoid haematoma. Risk factors found to be associated with fits were; GCS, hemiparesis, retained foreign body, intracerebral haemorraghe, multiple contusions and subarachnoid haemorrhage. Conclusion; The study demonstrated that early post traumatic seizures are strongly associated with poor outcome. It also showed that several risk factors may be associated with the development of seizures. Reducing the incidence of early post traumatic seizures should reduce the number of TBI patients with poor outcome. This can be done by giving seizure prophylaxis to TBI patients with risk factors for early post traumatic seizures on admission.