Association of Time to Continuous EEG Initiation With Outcomes in Critically Ill Patients

Continuous electroencephalography (cEEG) is used in the critical care setting for seizure detection and treatment, sedation management, and ischemia detection. Further evidence is needed to support whether early cEEG use can improve outcomes. We examined whether time from admission to cEEG initiation affects outcomes.

This is a single-center cohort study of critically ill adults (age > 18 years) who underwent cEEG monitoring within 7 days of admission from January to December 2019. Patients with anoxic brain injury were excluded. Time (hours) from admission to cEEG was recorded. Outcomes were in-hospital mortality and poor discharge modified Rankin Score (4-6). Results are reported as median [quartile range] and odds ratio (OR) [confidence intervals, CI].

In total, 464 patients met eligibility. Median time to cEEG was 23 hours [13, 52]. On multivariable analysis, increasing time to cEEG was associated with discharge mortality (OR, 1.006 [CI, 1.0002-1.013], 0.1%/hour [CI, 0.02-0.2]) and poor outcome (OR, 1.013 [CI, 1.005-1.020], 0.2%/hour [CI, 0.07-0.3]). Median time to cEEG initiation in patients with clinical concern for seizures/status at presentation ( n = 121) was 12 hours [6, 17] and in patients without clinical concern for seizures at presentation ( n = 343) was 31 hours [18, 66]. In patients without clinical concern for seizures/status epilepticus at presentation, time to cEEG continued to be associated with mortality (OR, 1.007 [CI, 1.001-1.014)] and poor outcome (OR, 1.012 [CI, 1.003-1.021]).

Increasing time to cEEG initiation was associated with higher mortality and worse outcomes. We hypothesize earlier cEEG results in timely interventions including treatment escalation and de-escalation that may improve outcomes.