Predictive factors and prevalence of acute symptomatic seizures among patients with acute traumatic brain injuries

Abstract

Introduction

Traumatic brain injuries (TBI) significantly contribute to hospital admissions in Europe. Acute symptomatic seizures (ASz), occurring within seven days post-TBI, increase morbidity and mortality. This study analyzes the frequency, risk factors, and short-term outcomes of ASz in patients with acute TBI.

Material and methods

This retrospective study included 212 patients with acute TBI admitted to the University Hospital Frankfurt/Germany between 2018 and 2021. Data were collected on demographics, injury characteristics, clinical course, and outcomes. ASz were defined as clinically or electroencephalographically detected seizures within seven days post-TBI. Logistic regression was used to identify predictors of ASz and non-convulsive status epilepticus (NCSE).

Results

ASz occurred in 17.9 % (n = 38) of patients, with a mean latency of 2.4 ± 1.9 days post-TBI. Status epilepticus developed in 47.4 % (n = 18) of these patients, predominantly as NCSE (n = 15). Predictors of ASz included older age (OR = 1.034, p = 0.012), higher Glasgow Coma Scale (GCS) at 24 h (OR = 1.133, p = 0.021), severe TBI (OR = 5.085, p = 0.018), and pneumonia (OR = 5.828, p = 0.007). For NCSE, significant predictors were older age (OR = 1.059, p = 0.021), pneumonia (OR = 6.766, p = 0.012), and urinary tract infection (OR = 7.38, p = 0.012). Patients with ASz had a significantly worse modified Rankin Scale (mRS) score at discharge (OR = 5.01, CI: 1.93–13.0, p < 0.001)).

Conclusion

ASz are a frequent and serious complication of TBI, particularly in severe cases and older patients. Early identification of high-risk patients using predictive factors such as age, GCS, and pneumonia may result in earlier treatment and improved outcomes. The findings highlight the importance of dedicated epilepsy monitoring in acute TBI care.