Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study

Fleischmann, Robert; Tränkner, Steffi; Bathe-Peters, R.; Rönnefarth, Maria; Schreiber, Stephan J.; Brandt, Stephan A.

doi:10.1177/1550059418767584

Cited by 21 publications

(32 citation statements)

References 76 publications

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“…In a cohort of non-sedated cardiothoracic surgery patients, eyes-closed EEG recording with two electrodes in a frontal-parietal derivation could distinguish delirious from non-delirious patients 246 . In a retro spective case-control study, quantitative EEG could distinguish delirious from non-delirious patients with a sensitivity of 100% and a specificity of 99% 247 . While advances in neuro-functional imaging and neurophysiology are likely to expand our understanding of delirium pathophysiology and the mechanistic basis of possible future treatments, the role of EEG in delirium screening and diagnosis remains undefined.…”

Section: Clinical Investigations Of Deliriummentioning

confidence: 96%

“…Neurophysiological correlates of delirium have been studied using EEG and quantitative EEG in small cohorts of patients 246,247 . In a cohort of non-sedated cardiothoracic surgery patients, eyes-closed EEG recording with two electrodes in a frontal-parietal derivation could distinguish delirious from non-delirious patients 246 .…”

Section: Clinical Investigations Of Deliriummentioning

confidence: 99%

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Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

571

602

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Section: Clinical Investigations Of Deliriummentioning

confidence: 96%

Section: Clinical Investigations Of Deliriummentioning

confidence: 99%

Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

571

602

View full text Add to dashboard Cite

“…Median EEG duration was 0.5 hours (0.3-30). The majority of patients (64%) were under continuous sedation during EEG, with propofol and/or midazolam; their median duration of mechanical ventilation was 8 days (4-14) and the median ICU stay was 11 days (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Resultsmentioning

confidence: 99%

“…EEG is part of standard diagnostic procedures of acute alteration of consciousness in the ICU, and may therefore prove useful to contribute to delirium diagnosis (7)(8)(9). Yet, clinical data on EEG in ICU delirium is limited (10,11), and to our knowledge, a comprehensive analysis of EEG characteristics in mechanically ventilated critically ill patients at high delirium risk has not been explored so far, especially in adults without known acute brain injury.…”

Section: Introductionmentioning

confidence: 99%

EEG characteristics of mechanically ventilated critically ill patients at high risk of delirium

Eskioglou

Iaquaniello

Alvarez

et al. 2020

Preprint

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Background Neurophysiological exploration of ICU delirium is limited. Here, we examined EEG characteristics of medical-surgical critically ill patients with new onset altered consciousness state at high risk for ICU delirium. Methods Pre-planned analysis of non-neurological mechanically ventilated medical-surgical ICU subjects, who underwent a prospective multicenter randomized, controlled EEG study (NCT03129438, April 2017-November 2018). EEG characteristics, according to the 2012 ACNS nomenclature, included background activity, rhythmic periodic patterns/epileptic activity, amplitude, frequency, stimulus-induced discharges, triphasic waves, reactivity and NREM sleep. We explored EEG findings in delirious vs. non-delirious patients, specifically focusing on presence of burst-suppression and rhythmic periodic patterns (ictal-interictal continuum), and epileptiform activity (ictal EEG). Results We analyzed 91 patients (median age, 66 years) who underwent EEG because of new onset altered consciousness state at a median 5 days from admission; 42 patients developed delirium (46%). Burst-suppression (10 vs. 0%, p = 0.02), rhythmic/periodic patterns (43% vs. 22%, p = 0.03) and epileptiform activity (7 vs. 0%, p = 0.05) were more frequent in delirious vs. non-delirious patients. The presence of at least one of these abnormal EEG findings (32/91 patients; 35%) was associated with a significant increase in the likelihood of delirium (42 vs. 15%, p = 0.006). Cumulative dose of sedatives and analgesics, as well as all other EEG characteristics, did not differ significantly between the two groups. Conclusion In mechanically ventilated non-neurological critically ill patients with new onset alteration of consciousness, EEG showing burst-suppression and/or ictal-interictal continuum findings indicates a higher risk of ICU delirium, independently of sedation and analgesia.

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“…Chart-based methods can furthermore increase the overall sensitivity when combined with interview methods in the first 72 hours, yet their sensitivity tends to be lower in the absence of psychomotor agitation or inappropriate behaviour when used stand-alone (49). (11,68). A recent review found that most research in the field was done in cardiovascular surgery or ICU patients limiting the generalizability of previous findings (67).…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

Müller

Nowak

Dewey

et al. 2018

Preprint

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Background Elderly people are a rapidly growing proportion of the world's population that increasingly undergo major elective spine surgery. They are yet at particular high risk for postoperative delirium (POD), which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency and cognitive dysfunction (POCD). It is insufficiently understood, which mechanisms and, particularly modifiable, risk factors contribute to the development of POD and POCD following these major but plannable surgeries. A better understanding thereof would help to adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study that is jointly conducted by the departments of Neurosurgery, Neurology and Anesthesiology at a tertiary care hospital in Germany. All patients presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Inclusion criteria are age ≥ 60 years, indication for elective spine surgery, ability to give informed consent without assistance and speaking German natively. Exclusion criteria include presence of neurodegenerative disease, diagnosis of any psychiatric disease, medication with central nervous system activity (e.g. antidepressants, antipsychotics, sedatives), impossibility to participate in follow-up, participation in an interventional trial, presence of electronic or displaceable metallic implants and active neoplasm. All patients are evaluated for their preoperative cognitive abilities and physical, mental and social health and wellbeing. They additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD and the investigation of markers of (neuro‑)inflammation. Preoperative examinations are repeated three months postoperatively to investigate the presence of POCD and its mechanisms. Discussion This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery including comprehensive pre- and postoperative assessments of cognitive abilities, markers of (neuro‑)inflammation, cerebral vasculature and structural and functional neuroimaging. The identification of, possibly common, mechanisms underlying POD and POCD would be a major step towards the definition of effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles.

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Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study

Cited by 21 publications

References 76 publications

Delirium

Delirium

EEG characteristics of mechanically ventilated critically ill patients at high risk of delirium

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

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