TY - JOUR

T1 - Continuous Versus Routine Standardized Electroencephalogram for Outcome Prediction in Critically Ill Adults

T2 - Analysis From a Randomized Trial

AU - Beuchat, Isabelle

AU - Rossetti, Andrea O.

AU - Novy, Jan

AU - Schindler, Kaspar

AU - Ruegg, Stephan

AU - Alvarez, Vincent

N1 - Publisher Copyright: Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PY - 2022

Y1 - 2022

N2 - OBJECTIVES: To investigate electroencephalogram (EEG) features’ relation with mortality or functional outcome after disorder of consciousness, stratifying patients between continuous EEG and routine EEG. DESIGN: Retrospective analysis of data from a randomized controlled trial. SETTING: Multiple adult ICUs. PATIENTS: Data from 364 adults with acute disorder of consciousness, randomized to continuous EEG (30–48 hr; n = 182) or repeated 20-minute routine electroencephalogram (n = 182). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Correlations between electrographic features and mortality and modified Rankin scale at 6 months (good 0–2) were assessed. Background continuity, higher frequency, and reactivity correlated with survival and good modified Rankin scale. Rhythmic and periodic patterns carried dual prognostic information: lateralized periodic discharges were associated with mortality and bad modified Rankin scale. Generalized rhythmic delta activity correlated with survival, good modified Rankin scale, and lower occurrence of status epilepticus. Presence of sleep-spindles and continuous EEG background was associated with good outcome in the continuous EEG subgroup. In the routine EEG group, a model combining background frequency, continuity, reactivity, sleep-spindles, and lateralized periodic discharges was associated with mortality at 70.91% (95% CI, 59.62–80.10%) positive predictive value and 63.93% (95% CI, 58.67–68.89%) negative predictive value. In the continuous EEG group, a model combining background continuity, reactivity, generalized rhythmic delta activity, and lateralized periodic discharges was associated with mortality at 84.62% (95%CI, 75.02–90.97) positive predictive value and 74.77% (95% CI, 68.50–80.16) negative predictive value. CONCLUSIONS: Standardized EEG interpretation provides reliable prognostic information. Continuous EEG provides more information than routine EEG.

AB - OBJECTIVES: To investigate electroencephalogram (EEG) features’ relation with mortality or functional outcome after disorder of consciousness, stratifying patients between continuous EEG and routine EEG. DESIGN: Retrospective analysis of data from a randomized controlled trial. SETTING: Multiple adult ICUs. PATIENTS: Data from 364 adults with acute disorder of consciousness, randomized to continuous EEG (30–48 hr; n = 182) or repeated 20-minute routine electroencephalogram (n = 182). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Correlations between electrographic features and mortality and modified Rankin scale at 6 months (good 0–2) were assessed. Background continuity, higher frequency, and reactivity correlated with survival and good modified Rankin scale. Rhythmic and periodic patterns carried dual prognostic information: lateralized periodic discharges were associated with mortality and bad modified Rankin scale. Generalized rhythmic delta activity correlated with survival, good modified Rankin scale, and lower occurrence of status epilepticus. Presence of sleep-spindles and continuous EEG background was associated with good outcome in the continuous EEG subgroup. In the routine EEG group, a model combining background frequency, continuity, reactivity, sleep-spindles, and lateralized periodic discharges was associated with mortality at 70.91% (95% CI, 59.62–80.10%) positive predictive value and 63.93% (95% CI, 58.67–68.89%) negative predictive value. In the continuous EEG group, a model combining background continuity, reactivity, generalized rhythmic delta activity, and lateralized periodic discharges was associated with mortality at 84.62% (95%CI, 75.02–90.97) positive predictive value and 74.77% (95% CI, 68.50–80.16) negative predictive value. CONCLUSIONS: Standardized EEG interpretation provides reliable prognostic information. Continuous EEG provides more information than routine EEG.

U2 - 10.1097/CCM.0000000000005311

DO - 10.1097/CCM.0000000000005311

M3 - Journal article

C2 - 34582427

AN - SCOPUS:85123969124

VL - 50

SP - 329

EP - 334

JO - New Horizons: Science and Practice of Acute Medicine

JF - New Horizons: Science and Practice of Acute Medicine

SN - 1063-7389

IS - 2

ER -