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Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005-2009
John P Ney1, David N van der Goes, Marc R Nuwer
1From the Departments of Neurology (J.P.N.) and Health Services (L.N.), University of Washington, Seattle; Department of Economics & Robert Wood Johnson Foundation (D.N.v.d.G), University of New Mexico, Albuquerque; Reed Neurological Research Center (M.R.N.), University of California, Los Angeles; and Department of Neurology (M.A.E.), Case Western Reserve University, Cleveland, OH.
Objectives:
To evaluate the effect of intensive care unit continuous EEG (cEEG) monitoring on inpatient mortality, hospital charges, and length of stay.
Methods:
A retrospective cross-sectional study was conducted using the Nationwide Inpatient Sample, a dataset representing 20% of inpatient discharges in nonfederal US hospitals. Adult discharge records reporting mechanical ventilation and EEG (routine EEG or cEEG) were included. cEEG was compared with routine EEG alone in association with the primary outcome of in-hospital mortality and secondary outcomes of total hospital charges and length of stay. Demographics, hospital characteristics, and medical comorbidity were used for multivariate adjustments of the primary and secondary outcomes.
Results:
A total of 40,945 patient discharges in the weighted sample met inclusion criteria, of which 5,949 had reported cEEG. Mechanically ventilated patients receiving cEEG were younger than routine EEG patients (56 vs 61 years; p < 0.001). There was no difference in the 2 groups in income or medical comorbidities. cEEG was significantly associated with lower in-hospital mortality in both univariate (odds ratio = 0.54, 95% confidence interval 0.45-0.64; p < 0.001) and multivariate (odds ratio = 0.63, 95% confidence interval 0.51-0.76; p < 0.001) analyses. There was no significant difference in costs or length of stay for patients who received cEEG relative to those receiving only routine EEG. Sensitivity analysis showed that adjusting for diagnosis-related groups (DRGs) for any neurologic diagnoses, DRGs for neurologic procedures, and specific DRGs for epilepsy/convulsions did not substantially alter the association of cEEG with reduced inpatient mortality.
Conclusions:
cEEG is favorably associated with inpatient survival in mechanically ventilated patients, without adding significant charges to the hospital stay.
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