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Does continuous electroencephalography influence therapeutic decisions in neurocritical care?

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@article{cd317719d08641c6afcaf6f61bdde50f,
title = "Does continuous electroencephalography influence therapeutic decisions in neurocritical care?",
abstract = "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.",
keywords = "antiepileptic treatment, brain injury, consciousness, epilepsy, prognostication, seizures, status epilepticus, Status Epilepticus Severity Score, Predictive Value of Tests, Seizures/diagnosis, Prognosis, Humans, Middle Aged, Male, Anticonvulsants/therapeutic use, Young Adult, Clinical Decision-Making, Aged, 80 and over, Adult, Female, Retrospective Studies, Severity of Illness Index, Electroencephalography/methods, Monitoring, Physiologic/methods, Aged, Cohort Studies",
author = "Sonja Holm-Yildiz and {Richter Hansen}, Julie and Vanessa Thonon and S{\'a}ndor Beniczky and Martin Fabricius and Annette Sidaros and Daniel Kondziella",
note = "{\textcopyright} 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",
year = "2021",
month = mar,
doi = "10.1111/ane.13364",
language = "English",
volume = "143",
pages = "290--297",
journal = "Acta Neurologica Scandinavica",
issn = "0001-6314",
publisher = "Wiley-Blackwell Munksgaard",
number = "3",

}

RIS

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 - 2021/3

Y1 - 2021/3

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 - antiepileptic treatment

KW - brain injury

KW - consciousness

KW - epilepsy

KW - prognostication

KW - seizures

KW - status epilepticus

KW - Status Epilepticus Severity Score

KW - Predictive Value of Tests

KW - Seizures/diagnosis

KW - Prognosis

KW - Humans

KW - Middle Aged

KW - Male

KW - Anticonvulsants/therapeutic use

KW - Young Adult

KW - Clinical Decision-Making

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Electroencephalography/methods

KW - Monitoring, Physiologic/methods

KW - Aged

KW - Cohort Studies

UR - http://www.scopus.com/inward/record.url?scp=85096669367&partnerID=8YFLogxK

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: 61137453