Does continuous electroencephalography influence therapeutic decisions in neurocritical care?
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Does continuous electroencephalography influence therapeutic decisions in neurocritical care? / Holm-Yildiz, Sonja; Richter Hansen, Julie; Thonon, Vanessa; Beniczky, Sándor; Fabricius, Martin; Sidaros, Annette; Kondziella, Daniel.
In: Acta Neurologica Scandinavica, Vol. 143, No. 3, 2021, p. 290-297.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Does continuous electroencephalography influence therapeutic decisions in neurocritical care?
AU - Holm-Yildiz, Sonja
AU - Richter Hansen, Julie
AU - Thonon, Vanessa
AU - Beniczky, Sándor
AU - Fabricius, Martin
AU - Sidaros, Annette
AU - Kondziella, Daniel
N1 - © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2021
Y1 - 2021
N2 - OBJECTIVES: In the neurocritical care unit (neuro-ICU), the impact of continuous EEG (cEEG) on therapeutic decisions and prognostication, including outcome prediction using the Status Epilepticus Severity Score (STESS), is poorly investigated. We studied to what extent cEEG contributes to treatment decisions, and how this relates to clinical outcome and the use of STESS in neurocritical care.METHODS: We included patients admitted to the neuro-ICU or neurological step-down unit of a tertiary referral hospital between 05/2013 and 06/2015. Inclusion criteria were ≥20 h of cEEG monitoring and age ≥15 years. Exclusion criteria were primary epileptic and post-cardiac arrest encephalopathies.RESULTS: Ninety-eight patients met inclusion criteria, 80 of which had status epilepticus, including 14 with super-refractory status. Median length of cEEG monitoring was 50 h (range 21-374 h). Mean STESS was lower in patients with favorable outcome 1 year after discharge (modified Rankin Scale [mRS] 0-2) compared to patients with unfavorable outcome (mRS 3-6), albeit not statistically significant (mean STESS 2.3 ± 2.1 vs 3.6 ± 1.7, p = 0.09). STESS had a sensitivity of 80%, a specificity of 42%, and a negative predictive value of 93% for outcome. cEEG results changed treatment decisions in 76 patients, including escalation of antiepileptic treatment in 65 and reduction in 11 patients.CONCLUSION: Status Epilepticus Severity Score had a high negative predictive value but low sensitivity, suggesting that STESS should be used cautiously. Of note, cEEG results altered clinical decision-making in three of four patients, irrespective of the presence or absence of status epilepticus, confirming the clinical value of cEEG in neurocritical care.
AB - OBJECTIVES: In the neurocritical care unit (neuro-ICU), the impact of continuous EEG (cEEG) on therapeutic decisions and prognostication, including outcome prediction using the Status Epilepticus Severity Score (STESS), is poorly investigated. We studied to what extent cEEG contributes to treatment decisions, and how this relates to clinical outcome and the use of STESS in neurocritical care.METHODS: We included patients admitted to the neuro-ICU or neurological step-down unit of a tertiary referral hospital between 05/2013 and 06/2015. Inclusion criteria were ≥20 h of cEEG monitoring and age ≥15 years. Exclusion criteria were primary epileptic and post-cardiac arrest encephalopathies.RESULTS: Ninety-eight patients met inclusion criteria, 80 of which had status epilepticus, including 14 with super-refractory status. Median length of cEEG monitoring was 50 h (range 21-374 h). Mean STESS was lower in patients with favorable outcome 1 year after discharge (modified Rankin Scale [mRS] 0-2) compared to patients with unfavorable outcome (mRS 3-6), albeit not statistically significant (mean STESS 2.3 ± 2.1 vs 3.6 ± 1.7, p = 0.09). STESS had a sensitivity of 80%, a specificity of 42%, and a negative predictive value of 93% for outcome. cEEG results changed treatment decisions in 76 patients, including escalation of antiepileptic treatment in 65 and reduction in 11 patients.CONCLUSION: Status Epilepticus Severity Score had a high negative predictive value but low sensitivity, suggesting that STESS should be used cautiously. Of note, cEEG results altered clinical decision-making in three of four patients, irrespective of the presence or absence of status epilepticus, confirming the clinical value of cEEG in neurocritical care.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Anticonvulsants/therapeutic use
KW - Clinical Decision-Making
KW - Cohort Studies
KW - Electroencephalography/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Monitoring, Physiologic/methods
KW - Predictive Value of Tests
KW - Prognosis
KW - Retrospective Studies
KW - Seizures/diagnosis
KW - Severity of Illness Index
KW - Young Adult
U2 - 10.1111/ane.13364
DO - 10.1111/ane.13364
M3 - Journal article
C2 - 33091148
VL - 143
SP - 290
EP - 297
JO - Acta Neurologica Scandinavica
JF - Acta Neurologica Scandinavica
SN - 0001-6314
IS - 3
ER -
ID: 280181610