Application of the 2HELPS2B Score for Seizure Detection in the ICU: Improving High-value Care
Abstract number :
3.16
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2204966
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
John Whalen, DO – University of North Carolina; Fazila Aseem, MD, MPH – University of North Carolina; Parin Nanavati, MD – University of North Carolina; Jessica Werdel, NP, MSN – University of North Carolina; Emily Fink, BS – University of North Carolina; Angela Wabulya, MBChB – University of North Carolina; Clio Rubinos, MD, MS – University of North Carolina; Casey Olm-Shipman, MD, MS – University of North Carolina; Suzette LaRoche, MD,FACNS, FAAN – University of North Carolina
Rationale: Continuous video EEG monitoring (cEEG) is a limited resource and must be used judiciously to achieve optimum results. The use of cEEG to detect nonconvulsive seizures (NCSz) has increased significantly over the last decade. Current guidelines recommend at least 24 hours of monitoring to detect NCSz. The 2HELP2B score, based on EEG parameters and patient factors, can help stratify seizure risk and aid in clinical decision making.1,2 We applied the 2HELPS2B score to improve cEEG utilization in our neurological ICU (NICU).
Methods: We included patients who were >18-years-old, required NICU level care and underwent cEEG at a tertiary center between June 2020 and May, 2022. Patients undergoing cEEG for status epilepticus treatment, ICP management and following cardiac arrest were excluded (n=184). Pre-intervention, chart reviews were conducted to record cEEG duration, incidence of seizures on cEEG and document 2HELPS2B score (based on EEG reports and clinical history). The intervention consisted of a daily touchpoint between the NICU attending and the reading epileptologist with communication of the 2HELPS2B score to aid with decision-making, focused on duration of cEEG. Post-intervention data was collected to evaluate the impact of implementing the 2HELPS2B risk score on cEEG duration and seizure incidence. _x000D_
Results: Of the 235 patients, most were in the low seizure risk category of 0 (n= 134, 57%), followed by moderate risk category of 1 (n=71, 30%). Pre-intervention, patients were monitored for similar durations for low and moderate risk categories (Table 1). Following implementation of the 2HELPS2B risk score, monitoring duration was reduced for all groups with significant reduction in the low-risk group (Table 1). As expected, patients in the high-risk group had higher incidence of seizures compared to low and moderate risk groups both pre- and post- intervention (Table 2). The seizure detection rate from pre- to post- intervention was unchanged for the low and moderate risk groups, but markedly reduced in the high-risk group. However, the statistical significance of this finding cannot be determined due to small sample size.
Conclusions: Most patients undergoing cEEG had low or moderate seizure risk which correlated with a low incidence of recorded seizures. Implementing the 2HELPS2B seizure risk score reduced the duration of monitoring in low and moderate risk patients without affecting seizure detection. High risk patients also had reduction in cEEG duration in addition to a notable decrease in seizure detection, however, sample size is too small to draw conclusions. Next steps are to continue to collect data to increase sample size and confirm these results, most importantly, whether these interventions inadvertently reduced seizure detection in high-risk patients. _x000D_
References:
1. Rodriguez RA, et al. Association of periodic and rhythmic electroencephalographic patterns with seizures in critically ill patients. JAMA Neurol. 2017;74(2):181-188._x000D_
2. Struck AF, et al. Assessment of the validity of the 2HELPS2B score for inpatient seizure risk prediction. JAMA Neurol. 2020;77(4):500-507.
Funding: None
Neurophysiology