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Meta-Analysis
. 2019 Oct;108(10):1841-1849.
doi: 10.1111/apa.14810. Epub 2019 Apr 29.

Systematic review and meta-analysis found significant risk of brain injury and neurosurgery in alert children after a post-traumatic seizure

Lorenzo Zanetto  1 , Liviana Da Dalt  1 , Marco Daverio  1 , Joel Dunning  2 , Anna Chiara Frigo  3 , Lise E Nigrovic  4 , Silvia Bressan  1
Affiliations
Meta-Analysis

Systematic review and meta-analysis found significant risk of brain injury and neurosurgery in alert children after a post-traumatic seizure

Lorenzo Zanetto et al. Acta Paediatr. 2019 Oct.

Abstract

Aim: This study aimed to determine the frequency of traumatic brain injury (TBI) on neuroimaging and the need for emergency neurosurgery in children with normal mental status following a post-traumatic seizure (PTS).

Methods: We searched six electronic databases from inception to October 15, 2018, to identify studies including children under 18 years with head injury and a Glasgow Coma Score of 15 after an immediate PTS. Relevant non-English articles were translated to determine eligibility.

Results: We performed random effect meta-analyses and assessed heterogeneity with I2 . The pooled estimate of the frequency of TBI, from seven studies, was 13.0% (95% CI: 4.0-26.1; I2 = 81%). Data on the need of emergency neurosurgery were reported in four studies and the pooled estimate of its frequency was 2.3% (95% CI: 0.0-9.9; I2 = 86%). Two studies reported on children with isolated PTS without any other signs of head injury, representing 0.1% of patients in both studies, for a total of 76 children. Of these, only three had TBI and one underwent neurosurgery.

Conclusion: Children with immediate PTS and normal mental status frequently have TBI with a substantial need for neurosurgery. Clinicians should strongly consider neuroimaging for these children, although prolonged observation may be considered for those with isolated PTS.

Keywords: Children; Emergency department; Head trauma; Post-traumatic seizure; Traumatic brain injury.

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