Continuous EEG is associated with favorable hospitalization outcomes for critically ill patients

Abstract

ObjectiveTo characterize continuous EEG (cEEG) use patterns in the critically ill and to determine the association with hospitalization outcomes for specific diagnoses.MethodsWe performed a retrospective cross-sectional study with National Inpatient Sample data from 2004 to 2013. We sampled hospitalized adult patients who received intensive care and then compared patients who underwent cEEG to those who did not. We considered diagnostic subgroups of seizure/status epilepticus, subarachnoid or intracerebral hemorrhage, and altered consciousness. Outcomes were in-hospital mortality, hospitalization cost, and length of stay.ResultsIn total, 7,102,399 critically ill patients were identified, of whom 22,728 received cEEG. From 2004 to 2013, the proportion of patients who received cEEG increased from 0.06% (95% confidence interval [CI] 0.03%–0.09%) to 0.80% (95% CI 0.62%–0.98%). While the cEEG cohort appeared more ill, cEEG use was associated with reduced in-hospital mortality after adjustment for patient and hospital characteristics (odds ratio [OR] 0.83, 95% CI 0.75–0.93, p < 0.001). This finding held for the diagnoses of subarachnoid or intracerebral hemorrhage and for altered consciousness but not for the seizure/status epilepticus subgroup. Cost and length of hospitalization were increased for the cEEG cohort (OR 1.17 and OR 1.11, respectively, p < 0.001).ConclusionsThere was a >10-fold increase in cEEG use from 2004 to 2013. However, this procedure may still be underused; cEEG was associated with lower in-hospital mortality but used for only 0.3% of the critically ill population. While administrative claims analysis supports the utility of cEEG for critically ill patients, our findings suggest variable benefit by diagnosis, and investigation with greater clinical detail is warranted.

Comparison of machine learning models for seizure prediction in hospitalized patients

“…Further, electrographic seizures are not limited to primarily neurological disease – critically ill patients with primary medical illness are at risk for seizures (10–12%) . Clinical evidence for cEEG includes studies of cost‐effectiveness, decreased mortality, and a dose–response relationship to electrographic seizure burden and outcomes …”

Post‐acute symptomatic seizure (PASS) clinic: A continuity of care model for patients impacted by continuous EEG monitoring

“…On the contrary, the overall risk for epilepsy development in this population is not high enough to warrant chronic AED therapy 21 . ASyS and epileptiform abnormalities, that may have been otherwise unrecognized, are becoming increasingly apparent with cEEG monitoring 3,4 . These findings may cause treating providers to start and continue, at times reflexively, an AED 6,7 .…”

“…The use of cEEG is more common in larger hospital systems 3 . In most centers, the team reading cEEG may not be involved in direct patient care.…”

“…Acute symptomatic seizures (ASyS), typically convulsive, account for 40% of all afebrile seizures with a 3.6% lifetime risk 1,2 . Over the past decade, there is a 10‐fold increase in continuous electroencephalogram (cEEG) monitoring for the detection of ASyS in hospitalized patients 3 . Based on the cEEG studies, around 50% 4 to 90% 5 of the ASyS detected are exclusively non‐convulsive seizures or status epilepticus (NCS/NCSE).…”

What's happening in Innovations in Care Delivery

“…The Innovations in Care Delivery blog, over the last several months, has discussed articles about the use of optical coherence tomography testing for the diagnosis of a prior unilateral optic neuritis 1 and use of continuous EEG monitoring. 2 Our goal is to highlight health services research articles published in Neurology ® or Neurology ® Clinical Practice, as well as to give opinions by experts in the field.…”