Validation of a Model for Targeted EEG Monitoring Duration in Critically Ill Children.

Autor:	Fung FW; Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Fan J; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Parikh DS; Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Vala L; Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Donnelly M; Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Jacobwitz M; Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Topjian AA; Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.; Department of Anesthesia & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Xiao R; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Abend NS; Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Department of Neurodiagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesia & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society [J Clin Neurophysiol] 2023 Nov 01; Vol. 40 (7), pp. 589-599. Date of Electronic Publication: 2022 Apr 20.
DOI:	10.1097/WNP.0000000000000940
Abstrakt:	Purpose: Continuous EEG monitoring (CEEG) to identify electrographic seizures (ES) in critically ill children is resource intense. Targeted strategies could enhance implementation feasibility. We aimed to validate previously published findings regarding the optimal CEEG duration to identify ES in critically ill children. Methods: This was a prospective observational study of 1,399 consecutive critically ill children with encephalopathy. We validated the findings of a multistate survival model generated in a published cohort ( N = 719) in a new validation cohort ( N = 680). The model aimed to determine the CEEG duration at which there was <15%, <10%, <5%, or <2% risk of experiencing ES if CEEG were continued longer. The model included baseline clinical risk factors and emergent EEG risk factors. Results: A model aiming to determine the CEEG duration at which a patient had <10% risk of ES if CEEG were continued longer showed similar performance in the generation and validation cohorts. Patients without emergent EEG risk factors would undergo 7 hours of CEEG in both cohorts, whereas patients with emergent EEG risk factors would undergo 44 and 36 hours of CEEG in the generation and validation cohorts, respectively. The <10% risk of ES model would yield a 28% or 64% reduction in CEEG hours compared with guidelines recommending CEEG for 24 or 48 hours, respectively. Conclusions: This model enables implementation of a data-driven strategy that targets CEEG duration based on readily available clinical and EEG variables. This approach could identify most critically ill children experiencing ES while optimizing CEEG use. Competing Interests: N. S. Abend: Funding from NIH (NINDS) K02NS096058 and Wolfson Foundation for this study. Other funding from PCORI (to institution), UCB Pharma (to institution), Epilepsy Foundation (consulting), and Demos Publishing (royalties). The remaining authors have no funding or conflicts of interest to disclose. (Copyright © 2022 by the American Clinical Neurophysiology Society.)
Databáze:	MEDLINE
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