Time Elapsed Between Admission and Initiation of Electroencephalography Is Independently Associated with Poor Outcomes in Critically Ill Adults
Abstract number :
1.156
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2205024
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Muhammad Adnan Haider, MD – Research Institute: Mass General Hospital, Boston_x000D_
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Current Institute: Florida Atlantic University Hospital; Mohammad Hamza Khalil, MD – Massachusetts General Hospital; Tanvi Jonnalagadda, BS – Massachusetts General Hospital; Marta Bento Fernandes, PhD – Massachusetts General Hospital; Lidia Moura, MD PhD – Massachusetts General Hospita; M. Brandon Westover, MD PhD – Massachusetts General Hospital; Sahar Zafar, MD MSc – Massachusetts General Hospital
This abstract has been invited to present during the Neurophysiology platform session
Rationale: Electroencephalographic epileptiform activity (seizures, periodic and rhythmic patterns) is seen in up to half of critically ill patients with altered mental status or coma. Increasing quantitative burden of epileptiform activity substantially increases the risk of poor outcomes in this patient population. The objective of this study was to determine the impact of increasing time to continuous electroencephalography (cEEG) initiation, and therefore detection of epileptiform activity, on outcomes in critically ill patients with altered mental status or coma.
Methods: We performed a retrospective analysis of critically ill adult patients (age >18 years) who underwent cEEG monitoring at a single center between 2016 and 2019. Baseline clinical and demographic variables, disease etiology and comorbidities were recorded. Time from admission to cEEG initiation, and cEEG findings were recorded. Primary outcome measure was in-hospital mortality and secondary outcome measure was poor discharge functional outcome (defined as modified Rankin Scale of 4-6).
Results: A total of 546 patients were included. Median age was 64 years; 47% (n=257) patients were female; median time to cEEG was 73 hours [quartile range, 36-227], 268 (49%) patients underwent cEEG within 73 hours of admission. Patients that were more likely to undergo cEEG within 73 hours vs. after 73 hours included those with higher illness severity (median Sequential Organ Failure Score of 7 vs. 3, p< 0.0001), prior history of epilepsy (17% vs. 5%, p< 0.0001) or brain injury (27% vs. 19%, p=0.03), clinical seizures on presentation (7% vs. 1%, p=0.0006), subarachnoid hemorrhage (16% vs. 10%, p=0.04). Patients with primary systemic illness were more likely to undergo cEEG after 73 hours (47% vs. 26% prior to 73 hours, p< 0.0001). There was no significant difference in the proportion of patients with ischemic and hemorrhagic stroke and traumatic brain injury that underwent cEEG prior to or after 73 hours of admission. There was no significant difference in the frequency of detection of electrographic seizures (11.2 % vs. 11.5%, p=1.0) and periodic/rhythmic patterns (58.6% vs. 61.2 % p=0.54) between patients undergoing cEEG prior to or after 73 hours. After adjusting for baseline demographics, illness severity, comorbidities, presenting diagnosis (e.g., seizures, acute brain injuries, primary systemic illness) and presence of epileptiform activity, increasing time to cEEG (in hours) was associated with increased probability of in-patient mortality (OR 1.80 [95% CI, 1.08- 3.01]) and poor functional outcomes (OR 3.56 [1.75-7.23]). In a stratified analysis of patients with primary systemic or non-neurologic illness, that are more likely to undergo cEEG monitoring later during admission, increasing time to cEEG continued to be significantly associated with increased mortality (OR 2.49 [1.18-5.26]).
Neurophysiology