Critical care EEG monitoring in children with abusive head trauma: A retrospective study of seizure burden and predictors of neurological outcomes

Objectives: Abusive Head Trauma (AHT) remains an important cause of acute seizures, morbidity, and mortality in children. We aimed to assess the clinical and electrographic seizure burden in children with AHT and to explore predictors of morbidity and mortality.

Methods: We conducted a retrospective chart review of all children admitted with AHT who underwent continuous electroencephalographic monitoring (cEEG) between January 1st, 2015, and April 15th, 2021. Their clinical, EEG and imaging variables were extracted and summarized.

Results: A total of 31 children (17 female) were included. The median age was 3 months (IQR 1.75-5). Forty-five percent of cases presented in the winter season (p = 0.024). In 25 cases out of 31, cEEG detected electrographic seizures, with 6 of these children not manifesting clinical seizures. A shorter time to first recorded seizure during cEEG was a significant predictor of in-hospital mortality (p = 0.012) and the maximum 1-hour seizure count was higher in children with worse cerebral outcomes (p = 0.008). A normal EEG background activity during cEEG was associated with favorable neurological outcomes (p = 0.008). The hospital mortality rate was 23 %.

Conclusion: Almost 20 % of children with AHT had seizures recognized exclusively by cEEG. Normal cEEG background activity predicted a better outcome, while a shorter time to the first recorded seizure was associated with a higher in-hospital mortality. Corroborating prior reports, we found a significant clustering of cases during the winter. These results could enhance AHT prevention strategies and case prognostication.