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Evidence Based Surgery

Shinuo Liu Dr Andrew Davidson

16/08/12

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Case

50 year old RHD CEO.

Tripped over dog. Moderate TBI.

Observation + PTAs

Put on phenytoin for 1 week.

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PICO

P = in ALL patients with traumatic brain injury

I = prophylactic anticonvulsants

C =

O = does it work? Is there a role?

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Keywords

• Traumatic brain injury• Head injury• Brain injury• Anticonvulsant*• Antiepileptic*• Prophyla*• Prevent*

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MEDLINE

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SCOPUS

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EMBASE

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Summary

Prophylactic phenytoin reduces the incidence of seizure in the first week after injury but not thereafter (?CMZ/PHB/VPA).

There is a role in suppression of early seizures in moderate to severe head injury.

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Indications (Khan and Banerjee (2010) Int J Emerg Med; 3:187–191)

• GCS score <10• Cortical contusions• Depressed skull fracture• Subdural haematoma• Epidural haematoma• Intracerebral haematoma• Penetrating head wound

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Our case

Supported by evidence!

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