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Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience

Institution:	1. Department of Pharmacy, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY, 11201, USA;2. Department of Pharmacy, St. Joseph''s University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA;3. Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA;4. Department of Surgery – Trauma Division, St. Joseph''s University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA;5. Department of Mathematical Sciences, New Jersey Institute of Technology, 323 Dr Martin Luther King Jr Blvd, Newark, NJ, 07102, USA;1. Department of Orthopedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52064, Aachen, Germany;2. Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy;3. Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England, UK;4. School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB Stoke on Trent, England, UK;5. Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim of the University Heidelberg, 68167 Mannheim, Germany;1. Children''s University Hospital, Temple St, Rotunda, Dublin 1, D01 XD99, Ireland;2. Cappagh Kids, National Orthopaedic Hospital Cappagh, Cappagh Rd, Cappoge, Dublin 11, D11 EV29 Ireland;3. UCD School of Medicine, University College Dublin, Belfield, Dublin 4 Ireland;1. Breast Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom;2. Breast Surgery, Royal Hampshire County Hospital, Hampshire, United Kingdom;3. The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom;4. Breast Surgery, Glenfield Hospital, Groby Road, Leicester, United Kingdom;5. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom;1. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy;2. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK;3. School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK;4. The London Independent Hospital, London, UK;5. Department of Medical Imaging, The London Independent Hospital, London, UK;1. King''s College London, Guy''s and St. Thomas'' Hospitals, King''s Health Partners, London, UK;2. Department of Urology, The London Clinic, W1G 6BW, UK;1. Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany;2. Institute of Psychology III, Unit of Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Germany;3. Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;4. Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;5. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Dresden, Dresden, Germany

Abstract:	IntroductionTraumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.Methods and materialsA single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018–July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).ResultsOf the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4–10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days 10.25 (8.5–15.5) vs 4 (1.5–4.5) days, p < 0.0001]. Electroencephalography-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1–7) and 7 (IQR 3–16) days, respectively.ConclusionsThe incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.

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