Anwar Zaman1, Randi Dubiel, Simon Driver, Monica Bennett, Vincent Diggs, Librada Callender. 1. Department of Physical Medicine and Rehabilitation (Drs Zaman, Dubiel, and Driver and Ms Callender), Baylor Institute for Rehabilitation, Dallas, Texas; and Office of the Chief Quality Officer, Baylor Scott and White Health, Dallas, Texas (Drs Bennett and Diggs).
Abstract
OBJECTIVE: To determine degree of adherence to guidelines for seizure prophylaxis following traumatic brain injury (TBI). SETTING: Tertiary care level 1 trauma center and affiliated inpatient rehabilitation facility. PARTICIPANTS: A total of 173 individuals with TBI who required inpatient rehabilitation from January 1, 2007, to December 31, 2013. DESIGN: Retrospective medical record review. MAIN MEASURES: Overutilization rate of prophylactic antiepileptic drugs (AEDs); failure to stop rate of AED utilization upon admission to and during inpatient rehabilitation; and duration of overutilization. RESULTS: Of the 173 participants included, 77 were started on seizure prophylaxis at hospital presentation and 96 were not. Of the 77 participants, 11 had a posttraumatic seizure. Of the 66 remaining, 18 participants (10.4%) were continued on AEDs for more than 7 days after injury. Of these 18 participants, 12 were continued on AEDs without indication upon admission to inpatient rehabilitation. Finally, 8 of the 12 were continued on AEDs at discharge from rehabilitation, resulting in a failure to stop rate of 66.67%. CONCLUSION: Despite existing guidelines for stopping seizure prophylaxis after TBI, some patients remain on AEDs and may be inappropriately exposed to possible medication side effects. These findings highlight the importance of communication at the time of rehabilitation transfer and the need for ongoing education about AED guidelines.
OBJECTIVE: To determine degree of adherence to guidelines for seizure prophylaxis following traumatic brain injury (TBI). SETTING: Tertiary care level 1 trauma center and affiliated inpatient rehabilitation facility. PARTICIPANTS: A total of 173 individuals with TBI who required inpatient rehabilitation from January 1, 2007, to December 31, 2013. DESIGN: Retrospective medical record review. MAIN MEASURES: Overutilization rate of prophylactic antiepileptic drugs (AEDs); failure to stop rate of AED utilization upon admission to and during inpatient rehabilitation; and duration of overutilization. RESULTS: Of the 173 participants included, 77 were started on seizure prophylaxis at hospital presentation and 96 were not. Of the 77 participants, 11 had a posttraumatic seizure. Of the 66 remaining, 18 participants (10.4%) were continued on AEDs for more than 7 days after injury. Of these 18 participants, 12 were continued on AEDs without indication upon admission to inpatient rehabilitation. Finally, 8 of the 12 were continued on AEDs at discharge from rehabilitation, resulting in a failure to stop rate of 66.67%. CONCLUSION: Despite existing guidelines for stopping seizure prophylaxis after TBI, some patients remain on AEDs and may be inappropriately exposed to possible medication side effects. These findings highlight the importance of communication at the time of rehabilitation transfer and the need for ongoing education about AED guidelines.