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Real-time seizure detection in paediatric intensive care patients: the RESET child brain protocol
Michaela Waak1,2, Kristen Gibbons2,3, Louise Sparkes4,2
1Queensland Children's Hospital Paediatric Intensive Care Unit, South Brisbane, Queensland, Australia michaela.waak@health.qld.gov.au.
Insights
Pediatric intensive care unit (PICU) nurses can accurately interpret quantitative electroencephalography (QEEG) trends for detecting seizures in children, improving upon traditional continuous electroencephalography (cEEG) monitoring.
Area of Science:
- Neuroscience
- Pediatric Critical Care
- Clinical Neurophysiology
Background:
- Electrographic-only seizures in critically ill children often go undetected due to limitations of continuous electroencephalography (cEEG) monitoring.
- High resource requirements currently limit the utility of high-quality cEEG assessment.
- Quantitative electroencephalography (QEEG) trend analysis software offers a potential solution for bedside cEEG assessment.
Purpose of the Study:
- To assess the accuracy of pediatric intensive care unit (PICU) nurses in interpreting QEEG trends compared to neurologist-assessed cEEG for seizure detection.
- To compare the time to seizure detection between QEEG interpretation and standard cEEG care.
- To identify confounders affecting seizure detection accuracy.
Main Methods:
- A prospective observational cohort study in a quaternary PICU involving 19-electrode QEEG analysis.
- Trained PICU nurses interpreted QEEG trends, marking seizures based on predefined criteria.
- Neurologists blinded to QEEG results performed post-hoc interpretation of cEEG to determine diagnostic test characteristics.
Main Results:
- The study aims to determine the sensitivity and specificity of QEEG interpretation by nurses.
- Sample size calculations suggest 80 patients are needed for sensitivity estimation with a 10% confidence interval width.
- Diagnostic test statistics will be used to evaluate the primary hypothesis.
Conclusions:
- QEEG trend analysis by PICU nurses shows promise for improving seizure detection in critically ill children.
- This approach may overcome limitations of traditional cEEG monitoring.
- Further research will elucidate the impact of confounders on accuracy and time to detection.
Introduction:
Approximately 20%-40% of comatose children with risk factors in intensive care have electrographic-only seizures; these go unrecognised due to the absence of continuous electroencephalography (EEG) monitoring (cEEG). Utility of cEEG with high-quality assessment is currently limited due to high-resource requirements. New software analysis tools are available to facilitate bedside cEEG assessment using quantitative EEG (QEEG) trends. The primary aim of this study is to describe accuracy of interpretation of QEEG trends by paediatric intensive care unit (PICU) nurses compared with cEEG assessment by neurologist (standard clinical care) in children at risk of seizures and status epilepticus utilising diagnostic test statistics. The secondary aims are to determine time to seizure detection for QEEG users compared with standard clinical care and describe impact of confounders on accuracy of seizure detection.
Methods And Analysis:
This will be a single-centre, prospective observational cohort study evaluating a paediatric QEEG programme utilising the full 19 electrode set. The setting will be a 36-bed quaternary PICU with medical, cardiac and general surgical cases. cEEG studies in PICU patients identified as 'at risk of seizures' will be analysed. Trained bedside clinical nurses will interpret the QEEG. Seizure events will be marked as seizures if >3 QEEG criteria occur. Post-hoc dedicated neurologists, who remain blinded to the QEEG analysis, will interpret the cEEG. Determination of standard test characteristics will assess the primary hypothesis. To calculate 95% (CIs) around the sensitivity and specificity estimates with a CI width of 10%, the sample size needed for sensitivity is 80 patients assuming each EEG will have approximately 9 to 18 1-hour epochs.
Ethics And Dissemination:
The study has received approval by the Children's Health Queensland Human Research Ethics Committee (HREC/19/QCHQ/58145). Results will be made available to the funders, critical care survivors and their caregivers, the relevant societies, and other researchers.
Trial Registration Number:
Australian New Zealand Clinical Trials Registry (ANZCTR) 12621001471875.
