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Published in: Journal of Neurology 6/2017

01-06-2017 | Original Communication

Use of EEG in critically ill children and neonates in the United States of America

Authors: Marina Gaínza-Lein, Iván Sánchez Fernández, Tobias Loddenkemper

Published in: Journal of Neurology | Issue 6/2017

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Abstract

The objective of the study was to estimate the proportion of patients who receive an electroencephalogram (EEG) among five common indications for EEG monitoring in the intensive care unit: traumatic brain injury (TBI), extracorporeal membrane oxygenation (ECMO), cardiac arrest, cardiac surgery and hypoxic-ischemic encephalopathy (HIE). We performed a retrospective cross-sectional descriptive study utilizing the Kids’ Inpatient Database (KID) for the years 2010–2012. The KID is the largest pediatric inpatient database in the USA and it is based on discharge reports created by hospitals for billing purposes. We evaluated the use of electroencephalogram (EEG) or video-electroencephalogram in critically ill children who were mechanically ventilated. The KID database had a population of approximately 6,000,000 pediatric admissions. Among 22,127 admissions of critically ill children who had mechanical ventilation, 1504 (6.8%) admissions had ECMO, 9201 (41.6%) TBI, 4068 (18.4%) HIE, 2774 (12.5%) cardiac arrest, and 4580 (20.7%) cardiac surgery. All five conditions had a higher proportion of males, with the highest (69.8%) in the TBI group. The mortality rates ranged from 7.02 to 39.9% (lowest in cardiac surgery and highest in ECMO). The estimated use of EEG was 1.6% in cardiac surgery, 4.1% in TBI, 7.2% in ECMO, 8.2% in cardiac arrest, and 12.1% in HIE, with an overall use of 5.8%. Among common indications for EEG monitoring in critically ill children and neonates, the estimated proportion of patients actually having an EEG is low.
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Literature
2.
go back to reference Hosain SA, Solomon GE, Kobylarz EJ (2005) Electroencephalographic patterns in unresponsive pediatric patients. Pediatr Neurol 32(3):162–165CrossRefPubMed Hosain SA, Solomon GE, Kobylarz EJ (2005) Electroencephalographic patterns in unresponsive pediatric patients. Pediatr Neurol 32(3):162–165CrossRefPubMed
3.
go back to reference Jette N et al (2006) Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 63(12):1750–1755CrossRefPubMed Jette N et al (2006) Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 63(12):1750–1755CrossRefPubMed
4.
go back to reference Abend NS, Dlugos DJ (2007) Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol 37(3):165–170CrossRefPubMed Abend NS, Dlugos DJ (2007) Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol 37(3):165–170CrossRefPubMed
5.
go back to reference Alehan FK, Morton LD, Pellock JM (2001) Utility of electroencephalography in the pediatric emergency department. J Child Neurol 16(7):484–487CrossRefPubMed Alehan FK, Morton LD, Pellock JM (2001) Utility of electroencephalography in the pediatric emergency department. J Child Neurol 16(7):484–487CrossRefPubMed
6.
go back to reference Shahwan A et al (2010) The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study. Epilepsia 51(7):1198–1204CrossRefPubMed Shahwan A et al (2010) The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study. Epilepsia 51(7):1198–1204CrossRefPubMed
7.
go back to reference Williams K, Jarrar R, Buchhalter J (2011) Continuous video-EEG monitoring in pediatric intensive care units. Epilepsia 52(6):1130–1136CrossRefPubMed Williams K, Jarrar R, Buchhalter J (2011) Continuous video-EEG monitoring in pediatric intensive care units. Epilepsia 52(6):1130–1136CrossRefPubMed
10.
go back to reference Tay SK et al (2006) Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 47(9):1504–1509CrossRefPubMed Tay SK et al (2006) Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 47(9):1504–1509CrossRefPubMed
11.
go back to reference Greiner HM et al (2012) Nonconvulsive status epilepticus: the encephalopathic pediatric patient. Pediatrics 129(3):e748–e755CrossRefPubMed Greiner HM et al (2012) Nonconvulsive status epilepticus: the encephalopathic pediatric patient. Pediatrics 129(3):e748–e755CrossRefPubMed
12.
go back to reference Saengpattrachai M et al (2006) Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia 47(9):1510–1518CrossRefPubMed Saengpattrachai M et al (2006) Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia 47(9):1510–1518CrossRefPubMed
13.
go back to reference Topjian AA et al (2013) Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med 41(1):215–223CrossRefPubMed Topjian AA et al (2013) Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med 41(1):215–223CrossRefPubMed
14.
15.
go back to reference Herman ST et al (2015) Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 32(2):87–95CrossRefPubMedPubMedCentral Herman ST et al (2015) Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 32(2):87–95CrossRefPubMedPubMedCentral
16.
go back to reference Shellhaas RA et al (2011) The American Clinical Neurophysiology Society’s Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol 28(6):611–617CrossRefPubMed Shellhaas RA et al (2011) The American Clinical Neurophysiology Society’s Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol 28(6):611–617CrossRefPubMed
18.
go back to reference Sanchez SM et al (2013) Pediatric ICU EEG monitoring: current resources and practice in the United States and Canada. J Clin Neurophysiol 30(2):156–160CrossRefPubMedPubMedCentral Sanchez SM et al (2013) Pediatric ICU EEG monitoring: current resources and practice in the United States and Canada. J Clin Neurophysiol 30(2):156–160CrossRefPubMedPubMedCentral
19.
20.
go back to reference Towne AR et al (2000) Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 54(2):340–345CrossRefPubMed Towne AR et al (2000) Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 54(2):340–345CrossRefPubMed
21.
go back to reference Westhall E (2017) Electroencephalography as a prognostic tool after cardiac arrest. Semin Neurol 37(1):48–59CrossRefPubMed Westhall E (2017) Electroencephalography as a prognostic tool after cardiac arrest. Semin Neurol 37(1):48–59CrossRefPubMed
23.
24.
go back to reference Rossetti AO et al (2010) Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 67(3):301–307PubMed Rossetti AO et al (2010) Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 67(3):301–307PubMed
25.
go back to reference Crepeau AZ et al (2013) Continuous EEG in therapeutic hypothermia after cardiac arrest: prognostic and clinical value. Neurology 80(4):339–344CrossRefPubMed Crepeau AZ et al (2013) Continuous EEG in therapeutic hypothermia after cardiac arrest: prognostic and clinical value. Neurology 80(4):339–344CrossRefPubMed
26.
go back to reference Kessler SK et al (2011) Short-term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest. Neurocrit Care 14(1):37–43CrossRefPubMedPubMedCentral Kessler SK et al (2011) Short-term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest. Neurocrit Care 14(1):37–43CrossRefPubMedPubMedCentral
27.
go back to reference Vespa PM et al (2002) Early and persistent impaired percent alpha variability on continuous electroencephalography monitoring as predictive of poor outcome after traumatic brain injury. J Neurosurg 97(1):84–92CrossRefPubMed Vespa PM et al (2002) Early and persistent impaired percent alpha variability on continuous electroencephalography monitoring as predictive of poor outcome after traumatic brain injury. J Neurosurg 97(1):84–92CrossRefPubMed
28.
go back to reference Abend NS et al (2010) Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care 12(3):382–389CrossRefPubMedPubMedCentral Abend NS et al (2010) Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care 12(3):382–389CrossRefPubMedPubMedCentral
29.
go back to reference Sanchez SM et al (2013) Electroencephalography monitoring in critically ill children: current practice and implications for future study design. Epilepsia 54(8):1419–1427CrossRefPubMedPubMedCentral Sanchez SM et al (2013) Electroencephalography monitoring in critically ill children: current practice and implications for future study design. Epilepsia 54(8):1419–1427CrossRefPubMedPubMedCentral
30.
go back to reference Gavvala J et al (2014) Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia 55(11):1864–1871CrossRefPubMed Gavvala J et al (2014) Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia 55(11):1864–1871CrossRefPubMed
33.
go back to reference Claassen J et al (2004) Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62(10):1743–1748CrossRefPubMed Claassen J et al (2004) Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62(10):1743–1748CrossRefPubMed
34.
go back to reference Abend NS, Topjian AA, Williams S (2015) How much does it cost to identify a critically ill child experiencing electrographic seizures? J Clin Neurophysiol 32(3):257–264CrossRefPubMedPubMedCentral Abend NS, Topjian AA, Williams S (2015) How much does it cost to identify a critically ill child experiencing electrographic seizures? J Clin Neurophysiol 32(3):257–264CrossRefPubMedPubMedCentral
35.
go back to reference Brophy GM et al (2012) Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 17(1):3–23CrossRefPubMed Brophy GM et al (2012) Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 17(1):3–23CrossRefPubMed
36.
go back to reference Herman ST et al (2015) Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol 32(2):96–108CrossRefPubMedPubMedCentral Herman ST et al (2015) Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol 32(2):96–108CrossRefPubMedPubMedCentral
37.
go back to reference Virnig BA, McBean M (2001) Administrative data for public health surveillance and planning. Annu Rev Public Health 22:213–230CrossRefPubMed Virnig BA, McBean M (2001) Administrative data for public health surveillance and planning. Annu Rev Public Health 22:213–230CrossRefPubMed
38.
39.
go back to reference Berman MF et al (2002) Use of ICD-9 coding for estimating the occurrence of cerebrovascular malformations. AJNR Am J Neuroradiol 23(4):700–705PubMed Berman MF et al (2002) Use of ICD-9 coding for estimating the occurrence of cerebrovascular malformations. AJNR Am J Neuroradiol 23(4):700–705PubMed
Metadata
Title
Use of EEG in critically ill children and neonates in the United States of America
Authors
Marina Gaínza-Lein
Iván Sánchez Fernández
Tobias Loddenkemper
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 6/2017
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-017-8510-3

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