Abstracts

Rationale: Electrographic seizures (ES) are common among critically ill children, but their relationship to outcome remains unclear. We evaluated the relationship between ES burden and short-term neurologic outcome among critically ill children, while controlling for diagnosis and illness severity.Methods: Prospective observational study of all infants and children admitted to our Pediatric and Cardiac Intensive Care Units who underwent clinically ordered continuous video-EEG (cEEG) monitoring over a 3-year period. Clinical and EEG characteristics were systematically collected, including two validated measures of illness severity, the Pediatric Risk of Mortality (PRISM-III), and the Pediatric Logistic Organ Dysfunction (PELOD) scores. Seizure burden was quantified for each subject by calculating the maximum percentage of any hour that was occupied by ES. Primary outcome measures included in-hospital mortality and decline in the 6-point validated Pediatric Cerebral Performance Category (PCPC) score between hospital admission and discharge.Results: 259 subjects underwent cEEG (51% male) with a median age of 2.2 years (IQR: 0.3d 9.7yr). The median ICU length of stay was 8 days (IQR: 4 17d) and median hospital length of stay was 23 days (IQR: 10 47d). The median PCPC scores were 1 (IQR: 1-2) at admission and 3 (IQR: 2-4) at hospital discharge. The median duration of cEEG monitoring was 37 hours (IQR: 21 56hr). ES occurred in 93 subjects (36%), with maximum seizure burden distributed as follows: 42 subjects (16%) had ES occupying <20%/hour, 28 (11%) had ES occupying 20-50%/hour, and 23 (9%) had ES occupying >