Authors :
Presenting Author: Ersida Buraniqi, MD – Children's National Hospital
Julia Keenan, BA – Children's National Hospital; Caroline Conley, DNP, CPNP AC-PC – Children's National Hospital; Katelyn Staso, MS, CPNP-AC – Children's National Hospital; Dana Harrar, MD, PhD – Children's National Hospital; Arnold Sansevere, MD – Children's National Hospital
Rationale:
This aims to characterize EEG background features, including epileptiform discharges (ED), as predictors for electrographic seizures (ES) and mortality in the Pediatric Intensive Care Unit (PICU).
Methods:
Prospective study of patients admitted to PICU at Children’s National Hospital from July 2021 to January 2023. We excluded patients with a known history of epilepsy and pre-existing cerebral injury. Clinical variables collected include age, sex, reason for admission, EEG background, electrographic seizures (ES), and mortality. Epileptiform discharges included sporadic discharges only and periodic and rhythmic patterns. EEG background, ES, and epileptiform discharges (ED) were defined in accordance with the American Clinical Neurophysiology Society standardized critical care EEG terminology. Descriptive statistics were used to describe the clinical variables. Specificity/sensitivity and odds ratio (OR) were applied to assess associations of EEG background features, seizures, and mortality. Results:
Two hundred one patients admitted to the PICU underwent continuous EEG monitoring; 40% were female and median age was 3.66 years. The most common admission diagnosis was new onset seizures (25%), followed by cardiac/respiratory arrest (23%), and traumatic brain injury (18%). The most common EEG background was slow/disorganized (72%) and background asymmetry (31%). Twenty-four percent of patients had EDs and 13% had ES, with the majority of ES being focal onset seizures (56%) (Table 1). Background slowing without ED or asymmetry was associated with the absence of seizures [OR 0.02 (0.002-0.4), P=0.01]. ED alone were associated with ES [OR 3.5 (1.3-9.4), P=0.02]; however, asymmetry alone was not associated with ES [OR 0.14 (0.02-1.1, P=0.07)]. The combination of ED and asymmetry was associated with higher sensitivity and specificity for ES [OR 57 (18.5-174, P< 0.0001] (Table 2). A slow disorganized background without EDs or asymmetry was associated with lower mortality when compared to other EEG background classification [OR 0.11 (95 CI 0.03-0.5), P< 0.004].