Abstracts

Rationale: Continuous electroencephalographic monitoring (cEEG) is important to assess critically ill patients in the pediatric intensive care unit (PICU). Despite expanding utilization of cEEG in the PICU and published standardized terminology for reporting EEG in critically ill patients (JCN 2013), it is unclear whether these reporting standards have been widely implemented. We aimed to assess the reporting of specific EEG variables from EEG reports of PICU patients. Methods: Retrospective study assessing EEG variables reporting from patients in the PICU obtained from the pediatric Status Epilepticus Research group (pSERG). Electrographic seizures (ES) were defined as abnormal, paroxysmal EEG events that were different from the background activity; duration lasting longer than 10 seconds, or shorter if associated with a clinical seizure; and, episodes that had a plausible EEG field with evolution in morphology and spatial distribution. Electrographic status epilepticus (ESE) was defined as either one seizure lasting greater than 30 minutes or a 1 hour seizure burden totaling 30 minutes of a one hour epoch. EEG reports were reviewed by trained pediatric encephalographers for variables expected to be part of ICU EEG reports given the ACNS standardized critical care terminology publication (JCN 2013). The variables were broken into subsets including: (1) background characteristics (presence or absence of interictal epileptiform discharges, periodic patterns and presence of testing for reactivity), (2) electrographic seizures (presence or absence of ES, time to first seizure, duration of seizure, and details of the clinical correlate for identified ES), (3) periodic and rhythmic patterns (presence of absence), and (4) burst suppression characteristics (burst duration, interburst duration, burst amplitude). For subjects with multiple ICU EEG days, only the first 24 hours were evaluated. Results: 191 reports were collected. The background was described in 96% (184/191) of reports. Of the 184 background descriptions presence or absence of interictal discharges were commented on in 79% (145/184) of reports. 5% (9/184) reported reactivity. 85 reports identified ES. 69% (59/85) of reports commented on the time to first seizure. The seizure location was identified in 94% (80/85), duration in 74% (63/85), and frequency in 69% (59/85) of reports. ESE was present in 28% (24/85) and was defined in 38% (9/24) of reports. Burst suppression was present in 14 reports. The interburst interval was described in 64% (9/14), amplitude of the bursts in 14% (2/14), and length of the bursts in 29% (4/14) of reports. Conclusions: This study suggests several areas of improvement when reporting PICU EEG data. Many components of EEG background and seizure characteristics are often not described in current reports. Implementation of standardized ICU EEG reports may help reviewers focus on important details, provide more uniform data to intensivists, and permit better data extraction for clinical research and quality improvement projects (Funded by the Pediatric Epilepsy Research Foundation). Funding: Funded by the Pediatric Epilepsy Research Foundation