Prevalence of late post-traumatic seizures and factors associated with their development in depressed skull fractures at Mulago National Referral Hospital

Abstract

Background Depressed skull fractures (DSF) are a common problem among head injured patients presenting at Mulago National Referral Hospital (MNRH) and they are sometimes associated with post traumatic seizures (PTS). However, the prevalence of PTS and the factors associated with the occurrence of PTS among patients with DSF at MNRH are not fully known. The anti-seizure medications commonly prescribed for these patients are also not well documented. Objectives To determine the prevalence of late PTS, the factors associated with the development of PTS, and to document commonly used anti-seizure medicines among patients with DSF at MNRH. Methods A cross-sectional study was conducted among participants who sustained DSF between March 2021 and February 2022 at MNRH. The participants were consecutively sampled using inclusion and exclusion criteria until desired sample size was obtained. The dependent variable was PTS and the independent variables included; radiological DSF characteristics, patient socio-demographics, CBC and electrolytes and use of anti-seizure medicines (ASM). Data on study variables was collected using a designed tool and the data was analyzed to determine the prevalence of late PTS and factors associated with occurrence of PTS among patients with DSF. Anti-seizure medicines commonly used in the management PTS in these patients at MNRH were documented. Results The mean age of study participants was 31.2, (SD: ±10.5) years, and the male to female ratio was 10:1. The literacy rate among study participants was 88.7%, having at least primary level of education with ability to read and write. The majority of study participants were peasants, 31.6% (105). The main mechanism of injury was assaults 52.3% (174) and the DSF involved multiple bones of the cranial vault in 35.7 % (118). The overall prevalence of PTS among DSF study participants at MNRH was 16.2% (54 participants). Comparatively, late PTS was the commonest, 9.0% (30) followed by early PTS, 13 (3.9%). Immediate PTS was the least category, 11 3.3%(11) in occurrence. All participants who has early PTS progressed to late PTS. On admission, majority, 59.5%(198) had mild TBI (GCS: 14-15). Moderate (GCS: 9-13), p<0.015 and severe (GCS: 3-8), p<0.026 TBI at the time of admission and midline brain shift (≥5mm), p<0.009 were significantly associated with PTS development. Phenytoin (94.3%) was xii the most commonly used ASM followed by phenobarbitone (1.4%) and Valproate (1.1%) among DSF study participants at MNRH. Conclusion The prevalence of late PTS was 9%, although on the overall, PTS occurred in 16.2% of DSF study participants at MNRH. Admission GCS of 9-13 and 3-8 and midline brain shift (≥5mm) were significantly associated with development of PTS. Posttraumatic seizures among study participants were commonly managed using Phenytoin.