Electroencephalography monitoring in critically ill children: current practice and implications for future study
Sarah M Sánchez1, Daniel H Arndt, Jessica L Carpenter
1Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, USA.
Insights
Continuous electroencephalography (CEEG) monitoring is increasingly used for critically ill children. Studies show practice variability, suggesting multicenter trials are feasible if standardized, but seizure variability must be considered.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neurophysiology
Background:
- Continuous electroencephalography (CEEG) monitoring is vital for detecting electrographic seizures in critically ill children.
- Current CEEG practice patterns in this population are not well-documented.
- Understanding CEEG utilization is crucial for designing effective clinical trials.
Purpose of the Study:
- To describe the clinical utilization of CEEG in critically ill children at North American tertiary care hospitals.
- To identify key variables for designing prospective multicenter studies on CEEG.
- To evaluate the impact of electrographic seizures on patient outcomes.
Main Methods:
- Retrospective enrollment of 550 critically ill children who underwent CEEG across 11 North American centers.
- Collection of data on patient characteristics, CEEG indications, and CEEG findings.
- Analysis of CEEG initiation timing, duration, and site-specific practices.
Main Results:
- CEEG indications included encephalopathy (67%), event characterization (38%), and refractory status epilepticus (11%).
- CEEG was initiated outside routine hours in 47% of cases; durations varied (>24h in 48%).
- Significant variability in CEEG indications and diagnoses existed, but electrographic seizure detection rates were similar across sites within diagnostic categories.
Conclusions:
- CEEG use in critically ill children shows considerable practice variability.
- Multicenter studies are feasible with standardized CEEG monitoring pathways.
- Electrographic seizure variability across sites and diagnoses must be accounted for in future research.
Purpose:
Survey data indicate that continuous electroencephalography (EEG) (CEEG) monitoring is used with increasing frequency to identify electrographic seizures in critically ill children, but studies of current CEEG practice have not been conducted. We aimed to describe the clinical utilization of CEEG in critically ill children at tertiary care hospitals with a particular focus on variables essential for designing feasible prospective multicenter studies evaluating the impact of electrographic seizures on outcome.
Methods:
Eleven North American centers retrospectively enrolled 550 consecutive critically ill children who underwent CEEG. We collected data regarding subject characteristics, CEEG indications, and CEEG findings.
Key Findings:
CEEG indications were encephalopathy with possible seizures in 67% of subjects, event characterization in 38% of subjects, and management of refractory status epilepticus in 11% of subjects. CEEG was initiated outside routine work hours in 47% of subjects. CEEG duration was <12 h in 16%, 12-24 h in 34%, and >24 h in 48%. Substantial variability existed among sites in CEEG indications and neurologic diagnoses, yet within each acute neurologic diagnosis category a similar proportion of subjects at each site had electrographic seizures. Electrographic seizure characteristics including distribution and duration varied across sites and neurologic diagnoses.
Significance:
These data provide a systematic assessment of recent CEEG use in critically ill children and indicate variability in practice. The results suggest that multicenter studies are feasible if CEEG monitoring pathways can be standardized. However, the data also indicate that electrographic seizure variability must be considered when designing studies that address the impact of electrographic seizures on outcome.
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