Electroencephalography monitoring in critically ill children: Current practice and implications for future study design

Authors

  • Sarah M. Sánchez,

    1. Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, U.S.A
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  • Daniel H. Arndt,

    1. Departments of Pediatrics and Neurology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, U.S.A
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  • Jessica L. Carpenter,

    1. Department of Neurology, Children's National Medical Center, Washington, District of Columbia, U.S.A
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  • Kevin E. Chapman,

    1. Division of Neurology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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  • Karen M. Cornett,

    1. Division of Neurology, Duke Children's Hospital and Duke University School of Medicine, Durham, North Carolina, U.S.A
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  • Dennis J. Dlugos,

    1. Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, U.S.A
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  • William B. Gallentine,

    1. Division of Neurology, Duke Children's Hospital and Duke University School of Medicine, Durham, North Carolina, U.S.A
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  • Christopher C. Giza,

    1. Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • Joshua L. Goldstein,

    1. Division of Neurology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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  • Cecil D. Hahn,

    1. Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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  • Jason T. Lerner,

    1. Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • Tobias Loddenkemper,

    1. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
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  • Joyce H. Matsumoto,

    1. Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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  • Kristin McBain,

    1. Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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  • Kendall B. Nash,

    1. Department of Neurology, University of California San Francisco, San Francisco, California, U.S.A
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  • Eric Payne,

    1. Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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  • Iván Sánchez Fernández,

    1. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
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  • Justine Shults,

    1. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, U.S.A
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  • Korwyn Williams,

    1. Department of Pediatrics, University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
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  • Amy Yang,

    1. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, U.S.A
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  • Nicholas S. Abend

    Corresponding author
    1. Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, U.S.A
    • Address correspondence to Nicholas S. Abend, Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Blvd, CTRB 10016, Pennsylvania, PA, U.S.A. E-mail: abend@email.chop.edu

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Summary

Purpose

Survey data indicate that continuous electroencephalography (EEG) (CEEG) monitoring is used with increasing frequency to identify electrographic seizures in critically ill children, but studies of current CEEG practice have not been conducted. We aimed to describe the clinical utilization of CEEG in critically ill children at tertiary care hospitals with a particular focus on variables essential for designing feasible prospective multicenter studies evaluating the impact of electrographic seizures on outcome.

Methods

Eleven North American centers retrospectively enrolled 550 consecutive critically ill children who underwent CEEG. We collected data regarding subject characteristics, CEEG indications, and CEEG findings.

Key Findings

CEEG indications were encephalopathy with possible seizures in 67% of subjects, event characterization in 38% of subjects, and management of refractory status epilepticus in 11% of subjects. CEEG was initiated outside routine work hours in 47% of subjects. CEEG duration was <12 h in 16%, 12–24 h in 34%, and >24 h in 48%. Substantial variability existed among sites in CEEG indications and neurologic diagnoses, yet within each acute neurologic diagnosis category a similar proportion of subjects at each site had electrographic seizures. Electrographic seizure characteristics including distribution and duration varied across sites and neurologic diagnoses.

Significance

These data provide a systematic assessment of recent CEEG use in critically ill children and indicate variability in practice. The results suggest that multicenter studies are feasible if CEEG monitoring pathways can be standardized. However, the data also indicate that electrographic seizure variability must be considered when designing studies that address the impact of electrographic seizures on outcome.

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