Introduction: Early post-traumatic seizures (EPTS), occurring within 7 days of traumatic brain injury (TBI), are associated with increased morbidity. While clinical predictors such as intracranial hemorrhage or low GCS, are well-established risk factors, the role of injury mechanism remains underexplored. In this study, we evaluate the association of different injury mechanisms in severe TBI (sTBI) and development of EPTS.
Methods: This was a retrospective cohort study conducted at a level 1 trauma center, which included adult TBI patients (≥18 years) admitted from April 2018 to June 2022. High impact (HI) injury was defined as injury with motor vehicle accidents, fall from tall heights and armed physical assault, whereas low impact (LI) injury was defined as ground level fall and unarmed assault. The primary endpoint was the incidence of EPTS. Secondary endpoints included hospital length of stay (LOS) and discharge disposition, categorized as: (1) independent (home or acute rehabilitation), (2) dependent (skilled nursing or long-term care), and (3) death or hospice care.
Results: Among 553 screened patients, 295 met inclusion criteria for sTBI of which 213 sustained HI, 59 LI and 23 penetrating injuries. EPTS incidence was higher in LI (20.3%) and penetrating (21.7%) injuries compared to HI (7.0%) on a pairwise statistical comparison (p 0.005 and 0.032, respectively). No difference was observed between LI and penetrating injuries (p = 1.00). LI injuries were associated with shorter LOS (13 days) compared to HI (19.2 days) and penetrating injuries (19.7 days) (p = 0.003). Discharge disposition showed borderline significance by injury mechanism (p = 0.054), with penetrating injuries yielding the highest rate of favorable independent outcomes (65.2%). LI injuries had the highest mortality or hospice rate (33.9%).
Conclusions: The mechanism of injury significantly influences seizure risk and outcomes in sTBI. In our study, LI and penetrating injuries were linked to higher seizure rates, with LI also associated with shorter LOS but worse mortality. Penetrating injuries showed more favorable discharge trends. These findings highlight the importance of incorporating injury mechanisms in early management strategies in TBI and prognostication.
