Early intervention vital following traumatic brain injury

Lead researcher Josh Laing looking at a brain scan

Reproduced from Alfred Health

Early intervention by neurologists following traumatic brain injury (TBI) could significantly enhance patient outcomes, researchers from The Alfred and Monash University have found.

The study, which evaluated risk factors associated morbidity and mortality following TBI found that patients who suffer seizures after moderate to severe TBI have an increased risk of serious complications.

Lead researcher Joshua Laing said that while those who suffer a seizure following TBI have a higher risk of death, they’re also more susceptible to further complications such as epilepsy years after the injury occurs.

"The study highlights the importance of early post-traumatic seizures on overall morbidity and mortality, additional to that of traumatic brain injury," Dr Laing said.

“While this was long suspected, this study provides significant evidence to support these theories and for possible revisions in how we manage people following TBI.”

The study followed 15,152 patients in the Victorian State Trauma Registry (VSTR)– many based at The Alfred - with moderate to severe TBI from January 2005 to December 2019. 

Professor Belinda Gabbe, second author on the study, heads the VSTR. She said that the VSTR is used to gather standardised data about all major trauma patients in Victoria. "The registry is a critical tool in helping to better understand the nature and incidence of serious injury occurring here, how we can prevent death and injury, and how to improve treatment to achieve better outcomes for patients. 

"Given the wide-ranging impacts of TBI on physical and mental health it's really wonderful to see the data we've collected being used to inform clinical practice and better support the recovery of people living with a TBI," said Prof Gabbe.

The study found that early post-traumatic seizures were associated with higher risks of Intensive Care Unit (ICU) admission, use of ventilation, length of hospital stay, and discharge to inpatient rehabilitation instead of home. 

“Not all patients with a TBI have seizures, but what this clearly shows is that those who do have them are far more likely to have other complications,” Dr Laing said.

“All patients who get admitted with a TBI get an anti-seizure drug. However, all the patients in this study had that medication and still had seizures on top of that.

“Often neurologists don’t get involved in a patient’s treatment until down the line, so maybe this means that there’s a need for us to get involved a little earlier."

Reference

Laing J, Gabbe B, Chen Z, Perucca P, Kwan P, O'Brien TJ. Risk Factors and Prognosis of Early Posttraumatic Seizures in Moderate to Severe Traumatic Brain Injury. JAMA Neurol. 2022 Feb 21:e215420. doi: 10.1001/jamaneurol.2021.5420. Epub ahead of print. PMID: 35188950; PMCID: PMC8861899.