TY - JOUR
T1 - Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery among Adult Inpatients
AU - Selioutski, Olga
AU - Roberts, Debra
AU - Hamilton, Ross
AU - Ghosh, Hia
AU - Nickels, Jean
AU - Toro, Francesca Konig
AU - Kruppenbacher, Matthew
AU - Auinger, Peggy
AU - Kaplan, Peter W.
AU - Birbeck, Gretchen L.
N1 - Funding Information:
O. Selioutski has received support from SAGE Therapeutics, Sepracor/ Sunovion, USL261 for being a primary investigator in industry-sponsored clinical trials. D. Roberts serves on the scientific advisory board of Cryothermic Systems. P. W. Kaplan has served on the board of the ACNS and the ABCN, received honoraria from Demos and Wiley-Blackwell for books on EEG and epilepsy; consultant to Lundbeck and Cadwell; been an expert witness on epilepsy and qEEG. G. L. Birbeck has received support from the US NIH for studies of epilepsy, seizures, malaria and HIV and from GlaxoSmithKline for consultation related to the antimalarial medication, Tafenoquine. She serves on the Board of Directors for the American Neurological Association and on the Advisory Board for the US National Institute of Health’s Fogarty International Center. None of these activities are related to the work presented here. The remaining authors have no funding or conflicts of interest to disclose.
Publisher Copyright:
Copyright © 2019 by the American Clinical Neurophysiology Society
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Purpose: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. Methods: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. Results: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19–0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79–5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34–8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale ($ 12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58–170.19; P = 0.02). Conclusions: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.
AB - Purpose: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. Methods: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. Results: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19–0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79–5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34–8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale ($ 12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58–170.19; P = 0.02). Conclusions: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.
KW - Continuous EEG monitoring
KW - ICU
KW - Outcomes
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U2 - 10.1097/WNP.0000000000000594
DO - 10.1097/WNP.0000000000000594
M3 - Article
C2 - 31491786
AN - SCOPUS:85071896901
SN - 0736-0258
VL - 36
SP - 358
EP - 364
JO - Journal of Clinical Neurophysiology
JF - Journal of Clinical Neurophysiology
IS - 5
ER -