Neurological vs. Non-neurological Primary Diagnoses in Relation to Outcomes of Long-term EEG in the ICU
Abstract number :
2.01
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2203943
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Hai Chen, MD, PhD – George Washington University; Eugenie Atallah, MD – George Washington University; Jennifer Pauldurai, MD – George Washington University; Andrew Becker, MD – George Washington University; Mohamad Koubeissi, MD – George Washington Unviersity
Rationale: Paroxysmal events occur frequently in critically ill patients. Long-term EEG monitoring (LTM) is crucial to characterize such events. Here, we compare patients in the neurointensive care unit to those in the medical ICU in terms of the LTM diagnostic yield and predictors of LTM outcomes.
Methods: We identified patients in the ICU who underwent LTM monitoring (> 6 h) that was ordered for the evaluation of paroxysmal events between January 1, 2018, and December 31, 2019. We extracted the admission diagnosis, demographics, medical history, neurological examination findings, brain imaging results, as well as the descriptions of the paroxysmal events that necessitated the monitoring. The LTM was dichotomized into either a diagnostic or a non-diagnostic study. Epileptiform discharges (ictal or interictal) and captured habitual events were considered diagnostic.
Results: We identified 159 LTM recordings that were obtained to characterize paroxysmal events. In this cohort, 100 patients were admitted with primary neurological diagnoses, such as intracranial hemorrhage or a brain tumor, among others. Fifty-nine patients were admitted to the medical ICU for non-neurological primary diagnoses. There was no significant difference in gender, age, or history of epilepsy between the two group. Patients in the neuro-ICU were more likely to have brain surgeries (53% vs. 7%), focal neurological deficits (66% vs. 13%) or abnormal brain imaging (86% vs. 28%). However, there was no significant difference in the LTM diagnostic yield between patients in the neuro-ICU and medical ICU (35% vs. 34%). History of epilepsy was a predictor of the LTM outcome.
Conclusions: Patients in the neuro-ICU are more likely to have abnormal neurological focal deficits or abnormal brain imaging compared with patients in the medical ICU. However, there is no significant difference in the LTM diagnostic yield ratio between the two groups. The history of epilepsy is the only predictor of the LTM outcome.
Funding: None
Neurophysiology