Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients

Olga Selioutski, Debra Roberts, Ross Hamilton, Hia Ghosh, Jean Nickels, Francesca Konig Toro, Matthew Kruppenbacher, Peggy Auinger, Peter W Kaplan, Gretchen L. Birbeck

Research output: Contribution to journalArticle

Abstract

PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.

Original languageEnglish (US)
Pages (from-to)358-364
Number of pages7
JournalJournal of clinical neurophysiology : official publication of the American Electroencephalographic Society
Volume36
Issue number5
DOIs
StatePublished - Sep 1 2019

Fingerprint

Inpatients
Electroencephalography
Status Epilepticus
Odds Ratio
Intensive Care Units
Glasgow Coma Scale
Seizures
Confidence Intervals
Epilepsy
Rehabilitation
Logistic Models
Skilled Nursing Facilities
Patient Care Planning
Demography
Mortality

ASJC Scopus subject areas

  • Physiology
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients. / Selioutski, Olga; Roberts, Debra; Hamilton, Ross; Ghosh, Hia; Nickels, Jean; Konig Toro, Francesca; Kruppenbacher, Matthew; Auinger, Peggy; Kaplan, Peter W; Birbeck, Gretchen L.

In: Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, Vol. 36, No. 5, 01.09.2019, p. 358-364.

Research output: Contribution to journalArticle

Selioutski, Olga ; Roberts, Debra ; Hamilton, Ross ; Ghosh, Hia ; Nickels, Jean ; Konig Toro, Francesca ; Kruppenbacher, Matthew ; Auinger, Peggy ; Kaplan, Peter W ; Birbeck, Gretchen L. / Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients. In: Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2019 ; Vol. 36, No. 5. pp. 358-364.
@article{6a477bb8f4924ad6be6eb4ab17cd5b59,
title = "Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients",
abstract = "PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95{\%} confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95{\%} confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95{\%} CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95{\%} confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.",
author = "Olga Selioutski and Debra Roberts and Ross Hamilton and Hia Ghosh and Jean Nickels and {Konig Toro}, Francesca and Matthew Kruppenbacher and Peggy Auinger and Kaplan, {Peter W} and Birbeck, {Gretchen L.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1097/WNP.0000000000000594",
language = "English (US)",
volume = "36",
pages = "358--364",
journal = "Journal of Clinical Neurophysiology",
issn = "0736-0258",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients

AU - Selioutski, Olga

AU - Roberts, Debra

AU - Hamilton, Ross

AU - Ghosh, Hia

AU - Nickels, Jean

AU - Konig Toro, Francesca

AU - Kruppenbacher, Matthew

AU - Auinger, Peggy

AU - Kaplan, Peter W

AU - Birbeck, Gretchen L.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.

AB - PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.

UR - http://www.scopus.com/inward/record.url?scp=85071896901&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071896901&partnerID=8YFLogxK

U2 - 10.1097/WNP.0000000000000594

DO - 10.1097/WNP.0000000000000594

M3 - Article

C2 - 31491786

AN - SCOPUS:85071896901

VL - 36

SP - 358

EP - 364

JO - Journal of Clinical Neurophysiology

JF - Journal of Clinical Neurophysiology

SN - 0736-0258

IS - 5

ER -