ArticleAnnals of clinical and translational neurology2021
Using electronic health data to explore effectiveness of ICU EEG and anti-seizure treatment.
Article in Annals of clinical and translational neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 14 citations in OpenAlex.
- Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures.JAMA neurology · 2024Article
- Clinical Impact of Standardized Interpretation and Reporting of Multimodality Neuromonitoring Data.Critical care explorations · 2024Observational
- How many patients do you need? Investigating trial designs for anti-seizure treatment in acute brain injury patients.Annals of clinical and translational neurology · 2024Article
- Predictors of follow-up care for critically-ill patients with seizures and epileptiform abnormalities on EEG monitoring.Clinical neurology and neurosurgery · 2024Article
- Identifying inpatient hospitalizations with continuous electroencephalogram monitoring from administrative data.BMC health services research · 2023Article
- Association of Epileptiform Activity With Outcomes in Toxic-Metabolic Encephalopathy.Critical care explorations · 2023Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesThe purpose of this study was to examine critical care continuous electroencephalography (cEEG) utilization and downstream anti-seizure treatment patterns, their association with outcomes, and generate hypotheses for larger comparative effectiveness studies of cEEG-guided interventions.
methodsSingle-center retrospective study of critically ill patients (n = 14,523, age ≥18 years). Exposure defined as ≥24 h of cEEG and subsequent anti-seizure medication (ASM) escalation, with or without concomitant anesthetic. Exposure window was the first 7 days of admission. Primary outcome was in-hospital mortality. Multivariable analysis was performed using penalized logistic regression.
resultsOne thousand and seventy-three patients underwent ≥24 h of cEEG within 7 days of admission. After adjusting for disease severity, ≥24 h of cEEG followed by ASM escalation in patients not on anesthetics (n = 239) was associated with lower in-hospital mortality (OR 0.76 [0.53-1.07]), though the finding did not reach significance. ASM escalation with concomitant anesthetic use (n = 484) showed higher odds for mortality (OR 1.41 [1.03-1.94]). In the seizures/status epilepticus subgroup, post cEEG ASM escalation without anesthetics showed lower odds for mortality (OR 0.43 [0.23-0.74]). Within the same subgroup, ASM escalation with concomitant anesthetic use showed higher odds for mortality (OR 1.34 [0.92-1.91]) though not significant.
interpretationBased on our findings we propose the following hypotheses for larger comparative effectiveness studies investigating the direct causal effect of cEEG-guided treatment on outcomes: (1) cEEG-guided ASM escalation may improve outcomes in critically ill patients with seizures; (2) cEEG-guided treatment with combination of ASMs and anesthetics may not improve outcomes in all critically ill patients.
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