Abstracts

Rationale: Electrodes are an essential element of clinical neurophysiology both for the recording of neural activity and electrical stimulation of the nervous system. Complications related to the use of recording electrodes are known to occur, but not much is known about the risk factors and incidence of such complications. The aim of this study is to identify the potential risk factors and incidence for electrode-related skin injuries. Methods: Between 11/2006 and 4/2009, 451 pediatric patients were monitored in the pediatric epilepsy monitoring unit (PEMU) and pediatric/neonatal intensive care units (ICU) using the 10-20 international system with the addition of T1, T2 and TP9 and TP10 electrodes. Skin assessment was performed in a prospective manner by the nurses prior to electrode placement and after monitoring was discontinued as part of a quality improvement program. The skin findings and materials used in electrode application were documented by the EEG technologists on a standardized data collection form. The forms were retrospectively reviewed in this IRB approved study. Data collected included: age at the time electrodes were initially placed, location of study, skin allergies, method of application, number of monitoring days, need for reapplication, presence or absence of skin breakdown, and location of the breakdown. Patients with incomplete data were excluded. Student’s t-test was used to analyze the data. Results: 166 patients were included. 53 out of 166 were PICU patients (32 %). Ages ranged between 1 day - 18 years, inclusive. Skin allergies were reported in 9 (5.3%) patients. Monitoring ranged from 1-10 days (mean 2). Breakdown (blister, abrasion, unspecified) following monitoring was seen in 22 patients (11.4% ). There was no significant difference in breakdown between PEMU (10.6%) and ICU (18.8%) patients (p=0.6). Three patients with breakdown had baseline skin allergies and 3 had preexisting skin abnormalities. In the PEMU, 10 patients with breakdown used 10/20 and EC2, 1 colloidon and 1 was unknown. In ICU patients, 9 patients with breakdown used 10/20 and EC2, and 1 was unknown. The mean duration of monitoring in PEMU patients with skin breakdown was 2.5 days compared to 1.8 days in those without breakdown (p=0.46). The mean duration of monitoring in PICU patients with breakdown was 4.8 days compared to 1.8 days in those without breakdown (p=0.5). The location of breakdown was frontal in 19, temporal in 2, and occipital in 2. Conclusions: Electrode-related skin breakdown is uncommon in children and had an incidence of 11.4% at our institution. However, the lack of compliance with skin assessment limits this conclusion. Patients monitored in PICU, longer duration of monitoring, pre-existing skin allergy and pre-existing breakdown, and frontal location were associated with higher incidences of skin breakdown, but none of these reached statistical significance. Future studies will be focused on improving the assessment frequency to determine which electrode materials are most associated with skin breakdown.