Does continuous electroencephalography influence therapeutic decisions in neurocritical care?

Abstract

Objectives In the neurocritical care unit (neuro‐ICU), the impact of continuous EEG (cEEG) on therapeutic decisions and prognostication, including outcome prediction using the Status Epilepticus Severity Score (STESS), is poorly investigated. We studied to what extent cEEG contributes to treatment decisions, and how this relates to clinical outcome and the use of STESS in neurocritical care. Methods We included patients admitted to the neuro‐ICU or neurological step‐down unit of a tertiary referral hospital between 05/2013 and 06/2015. Inclusion criteria were ≥20 h of cEEG monitoring and age ≥15 years. Exclusion criteria were primary epileptic and post‐cardiac arrest encephalopathies. Results Ninety‐eight patients met inclusion criteria, 80 of which had status epilepticus, including 14 with super‐refractory status. Median length of cEEG monitoring was 50 h (range 21–374 h). Mean STESS was lower in patients with favorable outcome 1 year after discharge (modified Rankin Scale [mRS] 0–2) compared to patients with unfavorable outcome (mRS 3–6), albeit not statistically significant (mean STESS 2.3 ± 2.1 vs 3.6 ± 1.7, p = 0.09). STESS had a sensitivity of 80%, a specificity of 42%, and a negative predictive value of 93% for outcome. cEEG results changed treatment decisions in 76 patients, including escalation of antiepileptic treatment in 65 and reduction in 11 patients. Conclusion Status Epilepticus Severity Score had a high negative predictive value but low sensitivity, suggesting that STESS should be used cautiously. Of note, cEEG results altered clinical decision‐making in three of four patients, irrespective of the presence or absence of status epilepticus, confirming the clinical value of cEEG in neurocritical care.

Prognostic scores in status epilepticus: A systematic review and meta‐analysis

“… 1–4,8,9,19–33 Six studies had high overall ROB, and the rest had unclear ROB (Figure S2). A total of 31 studies from 16 countries were included in the pooled analyses of sensitivity, specificity, PPV, and NPV (Table S4), including three studies that were identified after a review of references in the 28 initially selected studies 1–5,8–10,19–29,31–42 . Nine studies had high overall ROB, and the rest had unclear ROB (Figure S2).…”

“…A total of 31 studies from 16 countries were included in the pooled analyses of sensitivity, specificity, PPV, and NPV (Table S4), including three studies that were identified after a review of references in the 28 initially selected studies. [1][2][3][4][5][8][9][10][19][20][21][22][23][24][25][26][27][28][29][31][32][33][34][35][36][37][38][39][40][41][42] Nine studies had high overall ROB, and the rest had unclear ROB (Figure S2). The main reasons for ROB, both in AUC and sensitivity/ specificity/PPV/NPV analyses, were inadequate sample size according to PROBAST and narrow selection of participants (Figures S1 and S2).…”

Development and validation of a peripheral cell ratio and lactate score for differentiating status epilepticus from prolonged psychogenic nonepileptic seizures

“…Data were also collected on patient demographics, medical history, medications, radiological and EEG findings, and outcome measures such as modified Rankin Score (mRS; a score of 0-6), [29][30][31][32][33] length of stay, and intensive care unit (ICU) admission. Each event was analyzed for time of onset and offset, duration, motor or nonmotor features and for SE events, etiology, and severity.…”