Abstracts

Rationale: Inpatient continuous Electroencephalogram (cEEG) is an important diagnostic tool to identify and timely treat nonconvulsive seizures and status epilepticus. Nonconvulsive seizures can occur in up to 48% of critically ill patients (Herman, S. T. et al 2015). The goal of this study was to quantify and understand the number of patients at our facility who underwent cEEG exceeding 48 hours without seizures recorded and without intervention with antiseizure drugs and correlate with their 2HELPS2B score. Lessons from this would then be used to develop an enforceable model for inpatient EEG acquisition by utilizing 2HELPS2B scores to triage total EEG duration.


Methods: This is a retrospective analysis of 74 adult and pediatric patient records who underwent cEEG at VCU Health between November 2021 and October 2022. Patients were chart reviewed to calculate their 2HELPS2B score using MedCalc (Struck, Aaron F et al. 2020). Variables included age, duration on cEEG, ARCTIC (post cardiac arrest Advanced Resuscitation Cooling Therapeutics and Intensive protocol), Hypoxic ischemic encephalopathy (HIE), presence or absence of seizures on EEG, or whether any intervention with antiseizure drugs occurred based on CEEG data.


Results: Study included a total of 74 patients, 51 patients were adults (68.91%) and 24 were pediatric (32.43 %). There were 31 (41.89%) patients on continuous EEG with no interventions after being on cEEG between 0 to 8 days. One of the 31 patients was excluded due to withdrawal of care in status epilepticus. Data Analysis of the remaining 30 patients,16 adults and 14 pediatric patients underwent cEEG without intervention. In the adult population, ARCTIC protocol included 2 adult patients. The remaining 14 adult patients were placed on cEEG for various indications, such as subclinical seizure, concern for seizure, altered mental status, or intermittent aphasia. Subgroup analysis found 20 patients (11 adult and 9 pediatric) who underwent CEEG exceeding 48 hours without intervention. In the pediatric population, many patients on cEEG without intervention were monitored for HIE. Furthermore, 21.56% of adult patients on cEEG for over 48 hours without any seizures or interventions had a 2HELPS2B score ranging between 0 and 6 as illustrated in Figure 1, only one patient had a score of six and 54.54% of adult patients had a 2HELPS2B score of zero. Pediatric 2HELPS2B scores were also reported in Figure 1, many limitations exist in extrapolating this data as this scoring system has not been validated in children.

Conclusions: The inappropriate use of cEEG studies strains staff, equipment resources and most importantly, allocation of patient care away from those who exhibit or need investigation for status epilepticus. The 2HELPS2B score should be incorporated systemically as an objective tool alongside clinical judgment in adult patients on inpatient cEEG exceeding 48 hours to help guide duration of cEEG. This data will be used to develop, implement and study a structured stewardship model to guide appropriate inpatient cEEG duration and resources, particularly those with low 2HELPS2B scores below 3.


Funding: No Funding was Received.