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EEG in the Pediatric Intensive Care Unit: An Irish Experience
Laura MacDarby1, Martina Healy1, Gerard Curley2
1Department of Anesthesia and Critical Care, Children's Health Ireland at Crumlin (CHI at Crumlin), Dublin, Ireland.
Insights
Electroencephalography (EEG) provides crucial diagnostic information for pediatric intensive care unit (PICU) patients. However, limited EEG availability leads to high empirical use of antiepileptic drugs.
Area of Science:
- Pediatric Intensive Care
- Neurology
- Clinical Neurophysiology
Background:
- Continuous electroencephalography (EEG) monitoring is increasingly recognized as vital in the pediatric intensive care unit (PICU).
- Routine 24/7 EEG access is limited in many centers, impacting clinical decision-making.
- This study reviews EEG utilization in a tertiary PICU lacking 24/7 coverage.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical impact of EEG in a PICU setting with limited availability.
- To correlate EEG findings with clinical variables, including mortality.
- To assess the role of EEG in guiding clinical decisions and antiepileptic drug (AED) use.
Main Methods:
- Retrospective review of 108 pediatric intensive care unit patients.
- Analysis of 136 electroencephalography (EEG) recordings over 2.5 years.
- Correlation of EEG findings with clinical data, including mortality and sedation levels.
Main Results:
- Seizures were detected in 17% of patients, with most being subclinical and occurring early in recordings.
- Adverse EEG findings were associated with increased mortality.
- High rates of antiepileptic drug use were observed, regardless of EEG-detected seizures, and seizure prevalence decreased with higher sedation levels.
Conclusions:
- Electroencephalography (EEG) offers significant diagnostic value for a substantial number of pediatric intensive care unit patients.
- Limited EEG availability contributes to the frequent empirical prescription of antiepileptic drugs.
Introduction:
Evidence for continuous EEG monitoring in the pediatric intensive care unit (PICU) is increasing. However, 24/7 access to EEG is not routinely available in most centers, and clinical management is often informed by more limited EEG resources. The experience of EEG was reviewed in a tertiary PICU where 24/7 EEG cover is unavailable.
Methods:
Retrospective EEG and clinical review of 108 PICU patients. Correlations were carried out between EEG and clinical variables including mortality. The role of EEG in clinical decision making was documented.
Results:
One hundred ninety-six EEGs were carried out in 108 PICU patients over 2.5 years (434 hours of recording). After exclusion of 1 outlying patient with epileptic encephalopathy, 136 EEGs (median duration, 65 minutes; range, 20 minutes to 4 hours 40 minutes) were included. Sixty-two patients (57%) were less than 12 months old. Seizures were detected in 18 of 107 patients (17%); 74% of seizures were subclinical; 72% occurred within the first 30 minutes of recording. Adverse EEG findings were associated with high mortality. Antiepileptic drug use was high in the studied population irrespective of EEG seizure detection. Prevalence of epileptiform discharges and EEG seizures diminished with increasing levels of sedation.
Conclusions:
EEG provides important diagnostic information in a large proportion of PICU patients. In the absence of 24/7 EEG availability, empirical antiepileptic drug utilization is high.
