Blunt head trauma is common in children, and post-traumatic seizures are associated with traumatic brain injuries. Seizures are more common following severe head injuries, but they also can occur after minor head injuries. Despite the lack of data supporting hospitalization in children with post-traumatic seizures, patients often have been admitted for observation, regardless of neuroimaging results and neurologic status. Holmes and associates tested the hypothesis that children with immediate post-traumatic seizures who have normal cranial computed tomographic (CT) scan results and normal neurologic examinations can be sent home safely from the emergency department.
Using a prospective, observational cohort design, children who presented with immediate post-traumatic seizure after blunt head trauma were examined by cranial CT. All participants' guardians were contacted one week after emergency-department evaluation and questioned about symptoms of head injury. Outcomes included the presence or absence of neurologic complications and neurosurgical intervention.
Of the 63 children included in the study, 62 had brain CT scans; 10 of these found traumatic brain injury. These children were hospitalized. The 52 children with normal cranial CT scans were observed in the emergency department, as was one child who did not have a CT scan. Of the children with normal CT scans, 20 were hospitalized for a median of 1.5 days. The child who did not have a CT scan was discharged home from the emergency department. None of the hospitalized children had repeated seizures. Of the 32 children with negative CT scans who were sent home, follow-up of 31 children confirmed that none had further seizures, experienced neurologic deterioration, or required neurosurgery. Therefore, none of the children with immediate post-traumatic seizure with normal CT scans and neurologic examinations had any further seizures or sequelae.
The authors conclude that children with immediate post-traumatic seizures who have abnormalities on a head CT scan require hospitalization and neurologic evaluation. Children with immediate post-traumatic seizures, negative CT scans, and normal neurologic examinations are at low risk for neurologic sequelae that require hospitalization. These patients can be sent home directly from the emergency department.