Early Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric
Akilah Pascall1, Anqing Zhang2, Omar Dughly1
1Division of Critical Care Medicine, Children's National Medical Center, The George Washington University School of Medicine Washington, DC.
Insights
Continuous electroencephalography (cEEG) findings, along with clinical data, can predict short-term outcomes in pediatric traumatic brain injury (TBI) patients. This helps identify patients at risk for new disability or death after TBI.
Area of Science:
- Pediatric neurology
- Neurocritical care
- Clinical electrophysiology
Background:
- Traumatic brain injury (TBI) is a significant cause of death and disability in children.
- Predicting functional outcomes after pediatric TBI is crucial for guiding treatment and improving patient care.
Purpose of the Study:
- To investigate clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric TBI patients.
- To develop a hypothesis-generating model for predicting outcomes using cEEG data and clinical factors.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) admitted with TBI from 2010-2020.
- Analysis of clinical data, including Glasgow Coma Scale (GCS) and radiographic findings.
- Review of cEEG features within 72 hours of admission for association with mortality and new disability.
Main Results:
- 142 pediatric TBI patients were included; 30% experienced new disability or death.
- Favorable outcomes correlated with normal electroencephalogram background, reactivity, and sleep patterns (p < 0.001).
- A predictive model combining cEEG parameters, GCS, and radiographic findings demonstrated high predictive ability (0.94).
Conclusions:
- Specific acute cEEG findings are potential biomarkers for short-term functional outcomes in pediatric TBI.
- The developed model, integrating cEEG and clinical data, shows promise for outcome prediction.
- Further validation of this predictive model in diverse populations is warranted.
Objectives:
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes.
Design:
Retrospective cohort study.
Setting:
PICU within a quaternary care hospital.
Patients:
Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission.
Interventions:
None.
Measurements And Main Results:
Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features ( p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90-0.98).
Conclusions:
Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.
