Systematic review and meta‐analysis found significant risk of brain injury and neurosurgery in alert children after a post‐traumatic seizure

Aim This study aimed to determine the frequency of traumatic brain injury ( TBI ) on neuroimaging and the need for emergency neurosurgery in children with normal mental status following a post‐traumatic seizure ( PTS ). Methods We searched six electronic databases from inception to October 15, 2018, to identify studies including children under 18 years with head injury and a Glasgow Coma Score of 15 after an immediate PTS . Relevant non‐English articles were translated to determine eligibility. Results We performed random effect meta‐analyses and assessed heterogeneity with I 2 . The pooled estimate of the frequency of TBI , from seven studies, was 13.0% (95% CI: 4.0–26.1; I 2  = 81%). Data on the need of emergency neurosurgery were reported in four studies and the pooled estimate of its frequency was 2.3% (95% CI : 0.0–9.9; I 2  = 86%). Two studies reported on children with isolated PTS without any other signs of head injury, representing 0.1% of patients in both studies, for a total of 76 children. Of these, only three had TBI and one underwent neurosurgery. Conclusion Children with immediate PTS and normal mental status frequently have TBI with a substantial need for neurosurgery. Clinicians should strongly consider neuroimaging for these children, although prolonged observation may be considered for those with isolated PTS .