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EEG Monitoring in Critically Ill Children: Establishing High-Yield Subgroups.

France W Fung1,2, Darshana S Parikh1, Maureen Donnelly3

  • 1Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|March 9, 2023
PubMed
Summary

Stratifying critically ill children by electrographic seizure (ES) risk factors can optimize continuous EEG monitoring (CEEG) use. This approach identifies high-yield patient groups, potentially reducing resource intensity.

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Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Neurophysiology

Background:

  • Continuous EEG monitoring (CEEG) is vital for detecting electrographic seizures (ES) in critically ill children.
  • However, CEEG is resource-intensive, necessitating efficient utilization strategies.

Purpose of the Study:

  • To evaluate the impact of stratifying patients by known ES risk factors on CEEG utilization.
  • To determine if risk factor stratification can optimize resource allocation for CEEG.

Main Methods:

  • A prospective observational study involving critically ill children with encephalopathy undergoing CEEG.
  • Calculation of average CEEG duration needed to identify ES in the overall cohort and stratified subgroups based on risk factors.

Main Results:

  • ES occurred in 25% of 1,399 patients. The full cohort required 90 hours of CEEG to identify 90% of patients with ES.
  • Stratification by age, pre-CEEG clinical seizures, and early EEG risk factors revealed significant variations in CEEG duration needed (20 to 1,046 hours).
  • Patients with clinical seizures and early EEG risk factors required substantially less CEEG (20-22 hours) compared to those without (405-1,046 hours).

Conclusions:

  • Patient stratification by clinical and EEG risk factors effectively identifies high- and low-yield subgroups for CEEG.
  • This approach aids in optimizing CEEG resource allocation by considering ES incidence, duration, and subgroup size.