Prescription patterns for routine EEG ordering in patients with intracranial hemorrhage admitted to a neurointensive care unit
| Autor: | Muhammad U. Azeem, Susanne Muehlschlegel, Mehdi Ghasemi, Felicia Chu, Nils Henninger |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Critical Care Guidelines as Topic Electroencephalography Critical Care and Intensive Care Medicine Logistic regression Article 03 medical and health sciences 0302 clinical medicine medicine Humans In patient Neurointensive care unit Medical prescription Practice Patterns Physicians' Aged Retrospective Studies Intracerebral hemorrhage Aged 80 and over medicine.diagnostic_test business.industry Glasgow Coma Scale 030208 emergency & critical care medicine Middle Aged medicine.disease Hospitalization 030228 respiratory system EEG Findings Emergency medicine Female business Intracranial Hemorrhages |
| Zdroj: | Journal of critical care. 50 |
| ISSN: | 1557-8615 |
| Popis: | PURPOSE: To examine clinical factors, including established electroencephalography (EEG) consensus recommendations, that may influence EEG-prescription in critically-ill intracerebral hemorrhage (ICH) patients in the neurointensive care unit. METHODS: Retrospective analysis of 330 ICH patients admitted to a neurointensive care unit at an academic medical center between 01/2013–12/2015. We compared EEG prescription patterns with current EEG consensus recommendations, and employed univariate and multivariable logistic regression modeling to determine clinical variables associated with EEG ordering. RESULTS: Seventy-eight (41%) of 190 subjects underwent EEG in accordance with EEG-consensus guidelines, demonstrating an overall accuracy (probability that EEG prescription aligned with EEG consensus recommendations) of 64.6% (95%-CI 59.1–69.7). Factors independently associated with EEG ordering included fulfillment of EEG consensus recommendations, lower admission Glasgow Coma Scale (GCS), and presence of clinical seizures. The unadjusted and adjusted C-statistics for fulfillment of consensus recommendations was 0.74 (95%-CI 0.69–0.80) and 0.85 (95%-CI 0.81–0.90), respectively. Among 83 subjects undergoing EEG (25.2%), EEG findings informed clinical decision-making in 50 patients (60%). CONCLUSIONS: EEG appeared underused in ICH, since less than 50% of patients who fulfilled guideline criteria underwent EEG. Prescription of EEG was related to factors beyond those included in consensus recommendations. Validation of our findings and their association with outcome is required. |
| Databáze: | OpenAIRE |
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