Electrographic Seizures and Outcome in Critically Ill Children
Abstract number :
472
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2020
Submission ID :
2422814
Source :
www.aesnet.org
Presentation date :
12/6/2020 5:16:48 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Nicholas Abend, Children's Hospital of Philadelphia and University of Pennsylvania; Zi Wang - University of Pennsylvania; Darshana Parikh - Children's Hospital of Philadelphia; jacobwitz Marin - Children's Hospital of Philadelphia; Lisa Vala - Children's
Rationale:
Critically ill children with acute encephalopathy often undergo continuous EEG monitoring (CEEG) to identify electroencephalographic seizures (ES) based on the presumption that ES management may improve outcomes in some patients. ES may serve as biomarkers of worse injury yielding worse outcomes or may contribute to worse outcomes. We aimed to determine whether ES exposure burden was associated with unfavorable outcomes after adjustment for multiple variables reflecting brain injury type and severity.
Method:
We performed a prospective observational study of consecutive critically ill children with acute encephalopathy undergoing CEEG in the pediatric intensive care unit of a quaternary care institution between April 2017 and February 2019. ES exposure burden was assessed as none, ES, or electrographic status epilepticus (ESE). Outcomes were assessed at PICU discharge and included the Glasgow Outcome Scale - Extended Pediatric Version (GOS-E Peds) (primary outcome), Pediatric Cerebral Performance Category (PCPC), and mortality. Unfavorable outcome was defined as a reduction in GOS-E-Peds or PCPC score from pre-admission to PICU discharge. We used stepwise selection to develop final multivariate logistic regression models assessing the impact of ES exposure burden on outcomes while adjusting for variables reflecting acute brain injury type, encephalopathy severity, and critical illness severity.
Results:
We enrolled 719 consecutive critically ill subjects. Seizure exposure burden was none in 535 subjects (74%), ES in subjects 140 (19%), and ESE in 44 subjects (6%). The variables included in the multivariable logistic regression analyses were ES exposure, age dichotomized at 1-year, acute encephalopathy category, initial EEG background, comatose mental status at CEEG initiation, and Pediatric Risk of Mortality III. ES were not associated with worse outcomes. ESE was associated with unfavorable GOS-E-Peds (Odds Ratio 2.21 [95% Confidence Interval 1.07, 4.64]} and PCPC (Odds Ratio 2.17 [95% confidence interval 1.05, 4.51]) but not mortality.
Conclusion:
Among critically ill children with acute encephalopathy, ESE but not ES was associated with an increased risk of unfavorable neurobehavioral outcome even after adjusting for variables reflecting acute brain injury type, encephalopathy severity, and critical illness severity.
Funding:
:NIH K02NS096058, NIH U54-HD086984, and Wolfson Family Foundation.
Neurophysiology