Anne C Ritter1,2, Amy K Wagner2,3,4,5, Jerzy P Szaflarski6, Maria M Brooks1, Ross D Zafonte7, Mary Jo V Pugh8,9, Anthony Fabio1, Flora M Hammond10,11, Laura E Dreer12, Tamara Bushnik13, William C Walker14, Allen W Brown15, Doug Johnson-Greene16, Timothy Shea17, Jason W Krellman18, Joseph A Rosenthal17. 1. Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 2. Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 3. Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 4. Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 5. Center for Neuroscience at University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 6. Department of Neurology, University of Alabama at Birmingham Epilepsy Center, University of Alabama, Birmingham, Alabama, U.S.A. 7. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. 8. South Texas Veterans Health Care System Polytrauma Rehabilitation Center, San Antonio, Texas, U.S.A. 9. Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A. 10. Carolinas Rehabilitation, Charlotte, North Carolina, U.S.A. 11. Indiana University School of Medicine, Indianapolis, Indiana, U.S.A. 12. Departments of Physical Medicine and Rehabilitation and Ophthalmology, University of Alabama, Birmingham, Alabama, U.S.A. 13. Rusk Rehabilitation, New York University School of Medicine, New York, New York, U.S.A. 14. Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, U.S.A. 15. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, U.S.A. 16. Miller School of Medicine, University of Miami, Miami, Florida, U.S.A. 17. Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A. 18. Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Abstract
OBJECTIVE: 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. METHODS: 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). RESULTS: 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. SIGNIFICANCE: 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. Wiley Periodicals, Inc.
OBJECTIVE: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. METHODS: 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). RESULTS: 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. SIGNIFICANCE: 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. Wiley Periodicals, Inc.
Authors: Wesley T Kerr; Emily A Janio; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Norma L Gallardo; Janar Bauirjan; Andrea M Chau; Eric S Hwang; Emily C Davis; Albert Buchard; David Torres-Barba; Shannon D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel; Mark S Cohen; John M Stern Journal: Epilepsy Behav Date: 2018-02-02 Impact factor: 2.937
Authors: Harry Mee; Angelos G Kolias; Aswin Chari; Ari Ercole; Fiona Lecky; Carole Turner; Catrin Tudur-Smith; Jonathan Coles; Fahim Anwar; Antonio Belli; Mark Manford; Timothy Ham; Catherine McMahon; Diederik Bulters; Chris Uff; John S Duncan; Mark H Wilson; Anthony G Marson; Peter J Hutchinson Journal: Acta Neurochir (Wien) Date: 2018-10-01 Impact factor: 2.216
Authors: Jacqueline A French; Martina Bebin; Marc A Dichter; Jerome Engel; Adam L Hartman; Sergiusz Jóźwiak; Pavel Klein; James McNamara; Roy Twyman; Paul Vespa Journal: Epilepsia Open Date: 2021-07-29