Prognostic Features in Adults with Consciousness Impairment Undergoing Routine or Continuous EEG: Analysis of a Randomized Trial
Abstract number :
3.133
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2021
Submission ID :
1825634
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Andrea Rossetti, MD, FAES - CHUV; Isabelle Beuchat, MD – CHUV, Lausanne; Paola Vassallo, MD – CHUV, Lausanne; Kaspar Schindler, MD, PhD – Inselspital Bern; Vincent Alvarez, MD – Hôpital de Sion; CHUV, Lausanne; Stephan Rüegg, MD, FAES – Universistätsspital Basel
Rationale: In patients with disorder of consciousness (DoC), EEG is broadly used to detect mostly subclinical seizures or status epilepticus (SE), and assess prognosis. While several EEG features were described in this context, to date, the differential information obtainable from prolonged versus routine recordings has received little attention. This analysis investigates if specific electrographic features are related to mortality or functional outcome, stratifying patients between continuous (cEEG) and routine (rEEG) recordings.
Methods: We analyzed data of the recently published CERTA trial (NCT03129438), which randomized adults with DoC to two rEEG (20 min. each, 182 patients) or a cEEG (30-48 hours, 182 patients). Certified neurophysiologists prospectively interpreted EEGs using the standardized ACNS terminology. We explored correlations between the occurrence of several EEG features at any time and outcome (modified Rankin Scale, mRS; mortality) at 6 months, stratifying for the EEG intervention type.
Results: Regardless of the EEG type, increased background continuity (p < 0.05), reactivity (p < 0.01) and higher frequency (p < 0.05) significantly correlated to survival, and background frequency with better mRS (p < 0.05). In the cEEG group only, ictal features correlated with mortality (P <0.01), GRDA (p < 0.01) and spindles (p < 0.05) occurrence with survival and better mRS, and increasing continuity and reactivity (both p<0.01) with better mRS. In fact, ictal features (16% vs 4%, p=0.001), spindles (34% vs 12%, p=0.001), and GRDA (29% vs 16%, p=0.003) were found significantly more often in the cEEG arm. In this group, mortality (the trial primary outcome) was independently and inversely associated with spindles (OR 0.50, CI 95% 0.25-0.99), and increasing background continuity (OR 0.16, 95% CI: 0.07-0.41).
Neurophysiology