Evaluate the diagnostic yield of continuous electroencephalography (cEEG), describe associated outcomes, and identify predictors of seizure activity in pediatric patients following severe traumatic brain injury (sTBI).

Continuous EEG monitoring is frequently utilized for patients with sTBI; however, the clinical utility of this assessment is unclear and has not been well described.

Retrospective chart review was performed on patients < 18 years old who presented to our level-1 pediatric trauma center for sTBI (GCS<8 with evidence of intracranial injury) from 2016 to 2022. Demographic and event information, clinical and radiologic characteristics, cEEG reports, AED prescriptions, surgical interventions, and clinical outcomes were analyzed.

Over the study period, 151 pediatric patients were admitted with sTBI. Patients who underwent cEEG (n=60) were generally more severely injured, as evidenced by lower arrival GCS scores (5.5 vs. 6.5; p=0.018), higher Injury Severity Scores (30.2 vs. 25.9; p=0.023), and greater frequency of subdural hematomas (83.3% vs. 56.0%; p<0.001) and stroke (35.0% vs. 15.4%; p=0.006). This group had worse clinical outcomes, increased rates of surgery, ventilator days, and hospital length-of-stay. Within the cEEG group, 5 (8.3%) had a cEEG showing seizure activity, with 3/5 of these patients having a clinical seizure prior to arrival. All patients with a positive cEEG had subdural hematomas and stroke on imaging. Most (4/5) were infants (<12 months) with a history of possible NAT.

Pediatric patients with sTBI who undergo cEEG are generally those who present with more severe injuries that are associated with worse clinical outcomes. In this cohort, less than 10% of patients had electrographic seizure activity. Key presenting clinical features such as seizures prior to hospital arrival, lower GCS scores, higher Injury Severity Scores, and the presence of subdural hematomas or stroke on imaging are associated with positive cEEG findings and are strong indicators for its utilization.