Abstracts

Rationale: Skin breakdown’ as a result of prolonged continuous EEG monitoring (cEEG) in acutely hospitalized patients has recently gained national attention as a potentially preventable medical complication. We set out to measure the incidence and risk factors responsible for cEEG-related skin breakdown.Methods: We recorded the timing of all cEEG-related skin lesions, regardless of severity, among all consecutive patients who underwent cEEG from 4/1/2014 to 2/20/2015. Variables analyzed included cEEG duration, within-hospital location, electrode type, and adhesive type (paste vs. collodion), age, gender, and the presence of pressors, enteral nutrition, skin allergies, and fever. Variables found to be significant in a univariate analysis were analyzed in a multivariate logistic regression model to assess whether cEEG is an independent risk factor for ‘skin breakdown’.Results: Of 430 patients recorded during the study, 360 (84%) were adults and 70 (16%) were pediatric patients. cEEG-related skin breakdown occurred in 67 (15.33%) cases. Predictors of skin breakdown in univariate analysis included advanced age (p=0.004), presence of pressors (p=0.01), fever (p=0.004). In addition, EEG duration was longer in patients with skin breakdown: 4 days (SD=5) vs 1 day (SD=6) for patients without skin breakdown (p=0.0033). Multivariate logistic regression demonstrated a significant association of monitoring duration with risk of skin breakdown (OR= 1.49 [1.2-1.8], P<0.001) after controlling for pertinent clinical variables (age, wrap type, pressors use, fever).Conclusions: cEEG monitoring duration is an independent risk factor for cEEG-related skin breakdown. Patients who are elderly and those with more severe critical illness appear to be at greatest risk. Further research is needed to determine the spectrum and determinants of lesion severity, and to determine effective preventive measures.