Systematic Design of a Prognostic Scale for ICU Patients with Highly Epileptiform EEGs
Abstract number :
1.072
Submission category :
Year :
2001
Submission ID :
915
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
L.J. Hirsch, MD, Neurology/Comprehensive Epilepsy Center, Columbia Univ, New York, NY; J. Claassen, MD,PhD, Neurology/Critical Care Div, Columbia Univ, New York, NY; S.A. Mayer, MD, Neurology/Critical Care Div, Columbia Univ, New York, NY; R.G. Emerson, M
RATIONALE: There is no current method of predicting outcome in ICU patients with highly-epileptiform EEGs (HEEEGs: seizures [szs] or any periodic epileptiform discharges [PEDs]).
METHODS: We reviewed clinical and EEG data on 58 consecutive ICU patients with HEEEGs on prolonged scalp EEG monitoring. Using results of univariate analysis, and supplemented by data from the literature, we created a 5-part, 35-point scale to help predict mortality and functional outcome based on data available at diagnosis. The weighting of individual items in the scale was based upon odds ratios from the univariate analysis when possible. When our numbers were inadequate, they were supplemented by results from published literature.
RESULTS: : 1. [italic] Etiology [/italic] [anoxia=10, acute/progressive brain injury=8, toxic/metabolic/unknown=5, old brain injury w/out prior szs=3, old brain injury + prior szs=1, epilepsy or drug overdose=0]; 2. [italic] Age [/italic] [[gt]70=7, 50-70=5, [lt]50=3]; 3. [italic] Associated severe medical condition [/italic] [Acute=10, chronic=5, none=0]; 4. [italic] Exam [/italic] at diagnosis [coma=5, stupor=3, other=0]; 5. [italic] EEG [/italic] [bilateral or generalized PEDs or bilateral nonconvulsive status (NCSE)=3, unilateral PEDs or unilateral NCSE=2, szs only=1]. Maximum (worst) possible total score: 35.
HEEEG scores were normally distributed with a mean of 19 (s.d. 5.4, range 4-31), and were highly correlated with both mortality (Spearman correlation coefficient = 0.429, p=0.001) and Glasgow Outcome Scale (coefficient = 0.562, p[lt]0.001). Mortality was 65% in the 34 patients with a HEEEG score of 19 or greater, vs. 17% in the 24 patients with a HEEEG [lt] 19 (p[lt]0.001). All patients with a HEEEG score [lt] 12 had a good outcome (functioning independently), and all patients with a HEEEG [gt]23 had a bad outcome (vegetative or dead).
CONCLUSIONS: The HEEEG score is highly correlated with mortality and functional outcome in ICU patients with highly-epileptiform EEGs. These results need to be confirmed in an independent patient population to assess the clinical utility of this prognostic scale.