Incidence of PTE after TBI in Aviatorsasmameeting.org/asma2013_mp/pdfs/asma2013_present_412.pdf ·...
Transcript of Incidence of PTE after TBI in Aviatorsasmameeting.org/asma2013_mp/pdfs/asma2013_present_412.pdf ·...
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Henry Klein, MD, MOH
Lt Col, USAF, MC, FS
USAF School of Aerospace Medicine
WPAFB, OH
RAM 2013
Incidence of Post-Traumatic Incidence of Post-Traumatic Epilepsy after Traumatic Brain Epilepsy after Traumatic Brain
Injury in AviatorsInjury in Aviators
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Disclosure InformationDisclosure Information84th Annual Scientific Meeting84th Annual Scientific Meeting
Dr. Henry KleinDr. Henry Klein
I have no financial relationships to disclose.
I will not discuss off-label use and/or investigational use in our presentation.
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• Affects an estimated 1800 airmen each year• Risk adverse neuropsychological
consequences or post traumatic epilepsy • Mild – low risk
Background on TBIBackground on TBI
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• Few long term studies for the risk of PTE• Risk varies with clinical severity of injury
Post traumatic epilepsy (PTE)Post traumatic epilepsy (PTE)
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• Risk is highest in the first year – 100 fold• Still 20 fold after 5 years
* Severe
Post traumatic epilepsy (PTE) *Post traumatic epilepsy (PTE) *
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• Risk higher among subgroups • Intracranial bleeding• Subdural hematoma
Post traumatic epilepsy (PTE)Post traumatic epilepsy (PTE)
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Seizure Incidence by SeveritySeizure Incidence by Severity
Annegers. N Engl J Med 1998;338:20-4
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• At present, the population based data seems the most appropriate for comparison to risks for PTE in aviators.
• Airmen – healthier group than general population
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• Incidence of PTE in Aviators = Incidence of PTE in the general population
Null HypothesisNull Hypothesis
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• All FAA applicants for a medical certificate in the last 10 years that had a diagnosis of syncope or unconsciousness in the past medical history
• 4845 subjects
SelectionSelection
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Total Class 1 reviewed 725
Total Class 3 reviewed 320
Total records reviewed 1045
Records ReviewedRecords Reviewed
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TBI in class 1 131
TBI in class 3 14
Total TBI 145
Records positive for TBIRecords positive for TBI
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MILD MODERATE SEVERE
LOC or amnesia < 30’ LOC or amnesia > 30’ but< 24 hours or skull fracture
LOC or amnesia > 24 hours or presence of subdural hematoma or brain contusion
ClassificationClassification
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Class 1 Class 3 Person-years
Mild 100 6 1140
Moderate 6 0 56
Severe 25 8 381
ResultsResults
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TBI with seizures * TBI with seizures *
Class 1 1 Seizures for 3 months after TBI then no seizures. Followed for 29 years
Class 3 1 Seizures for 2 years then no seizures for 20 years.
Followed for 20 years
Total with Seizures 2
* All severe TBI
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severity Incidence Lower 95% ci Upper 95% ci
Mild or Moderate 0% 0% 3.6%
Severe 6.1% 1% 22%
Total 1.5% 0.2% 3.1%
ResultsResults
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• Consistent with civilian population data• No evidence for a “healthy airman” effect• Administrative data base as currently set up
cannot be used for surveillance or for monitoring of appropriateness of policy.
DiscussionDiscussion
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QUESTIONS?
THE ENDTHE END
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Seizure risk (%) by time Seizure risk (%) by time Severe injurySevere injury
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