Time to continuous electroencephalogram in repeated admissions to the pediatric intensive care unit
Iván Sánchez Fernández1, Arnold J Sansevere2, Marina Gaínza-Lein3
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Spain.
Insights
The time to continuous electroencephalogram (cEEG) monitoring after intensive care unit (ICU) admission did not improve with repeated admissions, even for patients with seizures. This suggests no significant change in cEEG initiation timing across multiple ICU stays.
Area of Science:
- Pediatric critical care medicine
- Neurophysiology
- Clinical informatics
Background:
- Continuous electroencephalogram (cEEG) monitoring is crucial for detecting non-convulsive seizures and other neurological events in critically ill patients.
- Repeated intensive care unit (ICU) admissions may offer opportunities to improve the timeliness of cEEG initiation.
- Understanding the temporal relationship between ICU admission and cEEG initiation is essential for optimizing patient care.
Purpose of the Study:
- To evaluate the time interval from intensive care unit (ICU) admission to the initiation of continuous electroencephalogram (cEEG) monitoring in pediatric patients with repeated ICU admissions.
- To determine if this time interval changes significantly across subsequent ICU admissions.
Main Methods:
- A retrospective observational study was conducted on pediatric patients admitted to the ICU between 2011 and 2013 who required repeated cEEG monitoring.
- The primary outcome measured was the duration from ICU admission to cEEG initiation.
- Statistical analysis compared this time interval between the first and second ICU admissions, including subgroups with electrographic seizures or status epilepticus.
Main Results:
- The study included 41 patients with at least two ICU admissions requiring cEEG.
- The median time from ICU admission to cEEG initiation was not significantly different between the first and second ICU admissions (10.7 hours vs. 13 hours).
- This lack of improvement in cEEG timing persisted even in patients who experienced seizures or status epilepticus during their initial ICU admission.
Conclusions:
- The time from ICU admission to cEEG initiation does not appear to shorten with subsequent ICU admissions in pediatric patients.
- Even in the presence of neurological emergencies like seizures or status epilepticus during the first admission, subsequent admissions did not show improved cEEG initiation timeliness.
- Further research may be needed to identify barriers and implement strategies to expedite cEEG initiation in critically ill children with recurrent ICU admissions.
Purpose:
Describe timing from intensive care unit (ICU) admission to initiation of continuous electroencephalogram (cEEG) in repeated ICU admissions.
Method:
We performed a retrospective observational study in pediatric patients who underwent repeated ICU admissions with cEEG from 2011 to 2013. The main outcome measure was time from ICU admission to cEEG.
Results:
There were 41 patients (54% males) with at least 2 ICU admissions with cEEG (median (p25-p75) age at first admission: 3.3 (0.3-8.4) years, at second admission: 3.9 (1.1-9.4) years), 7 patients (57% males, 9.9 (2.9-11.5) years) with at least 3 ICU admissions, and 5 patients (60% males, 10.1 (4-10.5) years) with at least 4 ICU admissions. One patient had 21 ICU admissions. The median (p25-p75) time from ICU admission to cEEG was not different during the first and second ICU admissions [10.7 (1.9-22.9) hours versus 13 (0.2-36.7) hours; p=0.908]. Among patients with electrographic seizures on first admission, time to cEEG was not different during the first and second admissions [7.9 (0.5-23.4) hours versus 14.5 (-2 to 44.5) hours; p=0.636]. Among patients with status epilepticus during the first admission, time to cEEG was not different between the first and second admissions [15.3 (9-79) hours versus 40.7 (19.3-42.6) hours; p=0.75].
Conclusions:
The time from ICU admission to the initiation of cEEG did not decrease in second or subsequent ICU admissions, even in patients with seizures or status epilepticus on the first admission.
