Rationale:
Although EEG is considered a non-invasive medical procedure, skin injury can be observed in patients undergoing continuous EEG (CEEG) studies. Preventing this complication is desirable in hospitalized patients. Clinical and EEG-related risk-factors associated with injury have been recognized but may vary among institutions. In this study, we evaluated the incidence of skin injury and associated risk factors to guide interventions which prevent such injury.
Methods:
We performed an observational investigation of continuous EEG-electrode-related skin injury in consecutive patients admitted to the epilepsy monitoring unit (EMU), critical care and other units who underwent CEEG over a 3-month period in 2025 at West Virginia University Hospital. The variables collected and analyzed were: age, sex, EEG technologist’s years of practice, number of monitoring sessions during hospitalization, presence of a skull defect, cranial surgery during hospitalization, intracranial hemorrhage, status epilepticus, duration of hospitalization, hair status (bald vs. not), admission to critical care unit, imaging performed during monitoring session, history of epilepsy, anti-seizure medication use, patient location (EMU vs not), fever, sedative use, vasopressor use, history of skin allergies, presence of head wrap, duration of EEG, admission diagnosis, indication for CEEG, type of nutrition, history of skin injury or skin disease. We identified and classified skin injury by the Florida electroneurodiagnostic skin health (FLESH) scale. Data was analyzed by grouping patients: any injury (FLESH score 1-5) vs. no injury (score 0) and severe injury (score 3-5) vs. no injury (score 0). Chi-square and t-test were used to compare groups.
Results:
Records of 75 patients (37 female; average age 51 years) were analyzed. Eighteen patients (24%) were electively admitted in the EMU. Skin injury (score 1-5) was noted in 36 patients (48%); 12 (16%) had severe skin injury (score 3-5). For the entire cohort the sole factor associated with any degree of skin injury was duration of EEG recording (61.44 vs. 36.35 hours [p < 0.01]). In the subgroup of patients with severe injury, factors associated with skin breakdown were duration of EEG recording (74.41 vs. 36.65 [p< 0.01] and admission to the EMU (5 of 12 patients vs. 4 of 39 [0.01]).
Conclusions:
Nearly half of the patients analyzed experienced some degree of skin injury while undergoing CEEG. Longer duration of recording and admission to the EMU were associated with a higher chance of skin breakdown. Funding: No funding was received for this study.