Abstracts

Utility of Continuous EEG Monitoring Reports: A Survey of Neurointensivists

Abstract number : 3.115
Submission category : 3. Neurophysiology
Year : 2015
Submission ID : 2327497
Source : www.aesnet.org
Presentation date : 12/7/2015 12:00:00 AM
Published date : Nov 13, 2015, 12:43 PM

Authors :
Gina Deck, M. Brandon Westover, Andrew Cole, Lidia Maria V. Moura

Rationale: Continuous EEG (cEEG) monitoring is increasingly utilized in the neurosciences intensive care unit (NICU). The American Clinical Neurophysiology Society (ACNS) published a cEEG terminology guideline. While adherence to these terms may increase reporting consistency between electroencephalographers, whether it betters communication with end-user physicians is unknown. We aim to describe how the use of standardized EEG reporting of non-specific patterns impacted the EEG interpretation of and clinical decisions by neurointensivists in one large academic medical center.Methods: A 15-item multiple-choice questionnaire was devised to assess the mode and frequency of communication between the reporting electroencephalographer and the primary team, the respondents’ interpretations of non-specific EEG patterns, and their knowledge of seizure patterns. It was sent to all practitioners in one NICU, including 10 neurointensivists, 2 critical care nurse practitioners and 11 NICU fellows. We summarized results using descriptive statistics including sample sizes and percentages.Results: 18/23 surveys were returned (78%) including 6/23 that were partially completed. Respondents report communication with the electroencephalographer occurred at least daily with 72% (13/18) reporting verbal communication and 89% (16/18) reading the EEG impression. Respondents asked to name EEG patterns requiring further correlation identified generalized (77%, or 10/13) or lateralized (69%; 9/13) periodic discharges, rhythmic delta activity (69%; 9/13) and stimulation induced patterns (54%; 7/13). Given an EEG reporting GPDs, potential correlations included hepatic failure (89%; 16/18) or toxic/metabolic derangements (83%; 15/18). There was no clear consensus about etiologies of LPDs and LRDA, with the most common responses noting an indeterminate pattern (38% and 50%; 6/16 and 8/16 respectively) or possible seizures (51% and 69%; 8/16 and 11/16 respectively). Most (59-75%; 10/17-12/16) reported that they would ideally discuss this finding with the reporting electroencephalographer, with a smaller portion gathering additional clinical data (25-41%; 4/16-7/17). When given additional information (that there was a clinical correlate to these patterns), all respondents would intervene with a benzodiazepine trial or AEDs. When asked to identify reported patterns consistent with electrographic seizures or status epilepticus, the majority, 77% (11/13) and 75% (8/12) respectively, were able to correctly identify these patterns.Conclusions: Despite continuous efforts to standardize EEG reports, most NICU practitioners still appear to be uncomfortable with independently interpreting and acting on certain EEG findings. Rather, they continue to rely heavily on verbal communication with the reporting electroencephalographer for assistance with interpretation and management related to patterns on the “ictal interictal continuum”. Clinical responses to these patterns also varied widely. The use of standardized terminology may have increased end-use awareness of the need for clinical correlation of reported EEG findings.
Neurophysiology