Electroencephalogram monitoring in critically ill children: indications and strategies
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Ana M Gutierrez-Colina1, Alexis A Topjian, Dennis J Dlugos
1Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Continuous electroencephalographic monitoring in pediatric intensive care units is resource-intensive. A brief-targeted strategy offers a high yield for detecting nonconvulsive seizures while minimizing resource use.
Area of Science:
- Pediatric critical care medicine
- Neurophysiology
- Health services research
Background:
- Continuous electroencephalographic (cEEG) monitoring frequently identifies nonconvulsive seizures in critically ill children.
- However, cEEG is resource-intensive and its impact on patient outcomes remains unproven.
- Variations in clinical monitoring pathways can significantly affect resource utilization and costs.
Purpose of the Study:
- To evaluate the impact of different monitoring duration strategies on resource utilization and nonconvulsive seizure detection in a pediatric intensive care unit (PICU).
- To inform the development of cost-effective clinical pathways for cEEG monitoring in critically ill children.
Main Methods:
- A 1-month prospective observational study was conducted in a 45-bed PICU.
- 247 patients were screened for potential cEEG monitoring indications.
- Resource utilization and seizure detection rates were calculated for two strategies: prolonged-targeted and brief-targeted monitoring.
Main Results:
- The prolonged-targeted strategy required an estimated 106 monitoring days per month, detecting 0.14 patients with seizures per day.
- The brief-targeted strategy required an estimated 33 monitoring days per month, detecting 0.43 patients with seizures per day.
- A brief-targeted strategy demonstrated a higher yield for identifying nonconvulsive seizures but risked missing some cases.
Conclusions:
- A brief-targeted strategy for cEEG monitoring in PICU patients offers a high yield for nonconvulsive seizure detection.
- This approach significantly reduces resource utilization compared to prolonged monitoring.
- Careful consideration of monitoring duration is crucial for optimizing resource allocation and cost-effectiveness in pediatric critical care.
Abstract:
Continuous electroencephalographic monitoring often detects nonconvulsive seizures in critically ill children, but it is resource-intense and has not been demonstrated to improve outcomes. As institutions develop clinical pathways for monitoring, they should consider how seemingly minor variations may exert substantial impacts on resource utilization and cost. In our 1-month prospective observational study, each patient in a 45-bed pediatric intensive care unit was screened for potential monitoring indications. We screened 247 patients. Minor differences in monitoring indications would exert substantial impact on resource utilization. We then calculated the number of monitoring days required each month, based on two strategies that differed in monitoring duration. The prolonged-targeted and brief-targeted strategies would have required 106 and 33 monitoring days, respectively. Based on nonconvulsive seizure occurrence data, these strategies would detect 0.14, and 0.43 patients with seizures per monitoring day performed, respectively. A brief-targeted strategy provides a high yield for nonconvulsive seizure identification, but would fail to diagnose some patients with seizures.
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