Pediatric Continuous EEG Monitoring Utilization: An 8-Year Cohort Study Using the Pediatric Health Information System
Whitney Fitts1, Craig Press1, Isabella Zaniletti2
1Division of Pediatric Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Insights
Continuous electroencephalography (CEEG) use in critically ill children has increased but varies by condition and hospital. Further research can optimize CEEG practices for better patient outcomes.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Clinical Neurophysiology
Background:
- Continuous electroencephalography (CEEG) is recommended for critically ill neonates and children at risk for seizures.
- Understanding trends and variations in CEEG utilization is crucial for optimizing care.
Purpose of the Study:
- To evaluate trends in CEEG use over time.
- To assess variations in CEEG utilization based on patient and hospital factors for six common indications.
Main Methods:
- Retrospective cohort study using data from 40 children's hospitals (2016-2023).
- Defined six CEEG indications: neonatal hypoxic-ischemic encephalopathy (HIE), extracorporeal membrane oxygenation, cardiac arrest, stroke, traumatic brain injury, and neonates postcardiac surgery (post-CS).
- Analyzed associations between CEEG use and various patient/hospital factors using multivariable generalized linear models.
Main Results:
- CEEG use varied significantly by condition, ranging from 21% (TBI, post-CS) to 67% (HIE).
- CEEG utilization increased over time for extracorporeal membrane oxygenation, post-CS, and cardiac arrest.
- Younger age and higher medical complexity were associated with increased CEEG use; no consistent patterns were found for race, insurance, or Child Opportunity Index.
Conclusions:
- CEEG utilization has risen but remains inconsistent across different conditions and healthcare facilities.
- Leveraging existing variations in CEEG practices through comparative effectiveness research can help identify optimal strategies.
Purpose:
Continuous electroencephalography (CEEG) is recommended in critically ill neonates and children at risk for experiencing seizures. Its utilization across time and conditions remains unclear. We evaluated trends in CEEG use and variation based on patient and hospital level factors for six common indications.
Methods:
This retrospective cohort study queried data from 40 children's hospitals in the Pediatric Health Information Systems database from January 2016 to December 2023. Using ICD-10 diagnosis codes, we defined six CEEG indications: neonatal hypoxic-ischemic encephalopathy (HIE), extracorporeal membrane oxygenation, cardiac arrest, stroke, traumatic brain injury, and neonates postcardiac surgery (post-CS). CEEG utilization was assessed annually. Associations between CEEG utilization and year, age, sex, race, history of seizures or epilepsy, medical complexity, payer, hospital region, and the Child Opportunity Index (COI) were evaluated in unadjusted ORs and an adjusted OR (aOR) in a multivariable generalized linear model.
Results:
CEEG use varied by condition: neonatal HIE 67%, extracorporeal membrane oxygenation 47%, cardiac arrest 39%, stroke 36%, traumatic brain injury 21%, and post-CS 21%. CEEG use increased over the study period for extracorporeal membrane oxygenation (aOR 4.65; 2.47-8.77; P < 0.001), post-CS (aOR 3.5; 1.36-8.99; P = 0.009), and cardiac arrest (aOR 1.95; 95% CI 1.22-3.12; P = 0.005). CEEG use varied by hospital and condition. Younger age and increased medical complexity were associated with higher odds of CEEG. There was no consistent pattern of CEEG variation by race, ethnicity, insurance type, or COI, although condition specific differences were present.
Conclusions:
CEEG utilization has increased over time but remains variable across hospitals and indications. Comparative effectiveness approaches that leverage variation could determine optimal CEEG practices.
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