Chloe E Hill1, Leah J Blank2, Dylan Thibault2, Kathryn A Davis2, Nabila Dahodwala2, Brian Litt2, Allison W Willis2. 1. From the Department of Neurology (C.E.H., L.J.B., D.T., K.A.D., N.D., B.L., A.W.W.), Leonard Davis Institute of Health Economics (C.E.H., N.D., A.W.W.), Translational Center of Excellence for Neurology Outcomes Research, Department of Neurology (D.T., A.W.W.), and Department of Biostatistics, Epidemiology and Informatics (A.W.W.), University of Pennsylvania, Philadelphia. chloehi@med.umich.edu. 2. From the Department of Neurology (C.E.H., L.J.B., D.T., K.A.D., N.D., B.L., A.W.W.), Leonard Davis Institute of Health Economics (C.E.H., N.D., A.W.W.), Translational Center of Excellence for Neurology Outcomes Research, Department of Neurology (D.T., A.W.W.), and Department of Biostatistics, Epidemiology and Informatics (A.W.W.), University of Pennsylvania, Philadelphia.
Abstract
OBJECTIVE: To characterize continuous EEG (cEEG) use patterns in the critically ill and to determine the association with hospitalization outcomes for specific diagnoses. METHODS: We performed a retrospective cross-sectional study with National Inpatient Sample data from 2004 to 2013. We sampled hospitalized adult patients who received intensive care and then compared patients who underwent cEEG to those who did not. We considered diagnostic subgroups of seizure/status epilepticus, subarachnoid or intracerebral hemorrhage, and altered consciousness. Outcomes were in-hospital mortality, hospitalization cost, and length of stay. RESULTS: In total, 7,102,399 critically ill patients were identified, of whom 22,728 received cEEG. From 2004 to 2013, the proportion of patients who received cEEG increased from 0.06% (95% confidence interval [CI] 0.03%-0.09%) to 0.80% (95% CI 0.62%-0.98%). While the cEEG cohort appeared more ill, cEEG use was associated with reduced in-hospital mortality after adjustment for patient and hospital characteristics (odds ratio [OR] 0.83, 95% CI 0.75-0.93, p < 0.001). This finding held for the diagnoses of subarachnoid or intracerebral hemorrhage and for altered consciousness but not for the seizure/status epilepticus subgroup. Cost and length of hospitalization were increased for the cEEG cohort (OR 1.17 and OR 1.11, respectively, p < 0.001). CONCLUSIONS: There was a >10-fold increase in cEEG use from 2004 to 2013. However, this procedure may still be underused; cEEG was associated with lower in-hospital mortality but used for only 0.3% of the critically ill population. While administrative claims analysis supports the utility of cEEG for critically ill patients, our findings suggest variable benefit by diagnosis, and investigation with greater clinical detail is warranted.
OBJECTIVE: To characterize continuous EEG (cEEG) use patterns in the critically ill and to determine the association with hospitalization outcomes for specific diagnoses. METHODS: We performed a retrospective cross-sectional study with National Inpatient Sample data from 2004 to 2013. We sampled hospitalized adult patients who received intensive care and then compared patients who underwent cEEG to those who did not. We considered diagnostic subgroups of seizure/status epilepticus, subarachnoid or intracerebral hemorrhage, and altered consciousness. Outcomes were in-hospital mortality, hospitalization cost, and length of stay. RESULTS: In total, 7,102,399 critically illpatients were identified, of whom 22,728 received cEEG. From 2004 to 2013, the proportion of patients who received cEEG increased from 0.06% (95% confidence interval [CI] 0.03%-0.09%) to 0.80% (95% CI 0.62%-0.98%). While the cEEG cohort appeared more ill, cEEG use was associated with reduced in-hospital mortality after adjustment for patient and hospital characteristics (odds ratio [OR] 0.83, 95% CI 0.75-0.93, p < 0.001). This finding held for the diagnoses of subarachnoid or intracerebral hemorrhage and for altered consciousness but not for the seizure/status epilepticus subgroup. Cost and length of hospitalization were increased for the cEEG cohort (OR 1.17 and OR 1.11, respectively, p < 0.001). CONCLUSIONS: There was a >10-fold increase in cEEG use from 2004 to 2013. However, this procedure may still be underused; cEEG was associated with lower in-hospital mortality but used for only 0.3% of the critically ill population. While administrative claims analysis supports the utility of cEEG for critically illpatients, our findings suggest variable benefit by diagnosis, and investigation with greater clinical detail is warranted.
Authors: Jay Gavvala; Nicholas Abend; Suzette LaRoche; Cecil Hahn; Susan T Herman; Jan Claassen; Mícheál Macken; Stephan Schuele; Elizabeth Gerard Journal: Epilepsia Date: 2014-09-29 Impact factor: 5.864
Authors: Aaron F Struck; Mohammad Tabaeizadeh; Sarah E Schmitt; Andres Rodriguez Ruiz; Christa B Swisher; Thanujaa Subramaniam; Christian Hernandez; Safa Kaleem; Hiba A Haider; Abbas Fodé Cissé; Monica B Dhakar; Lawrence J Hirsch; Eric S Rosenthal; Sahar F Zafar; Nicholas Gaspard; M Brandon Westover Journal: JAMA Neurol Date: 2020-04-01 Impact factor: 18.302
Authors: Taneeta Mindy Ganguly; Colin A Ellis; Danni Tu; Russell T Shinohara; Kathryn A Davis; Brian Litt; Jay Pathmanathan Journal: Neurology Date: 2022-04-11 Impact factor: 11.800
Authors: Michael C Jin; Jonathon J Parker; Michael Zhang; Zack A Medress; Casey H Halpern; Gordon Li; John K Ratliff; Gerald A Grant; Robert S Fisher; Stephen Skirboll Journal: J Neurosurg Date: 2021-05-14 Impact factor: 5.115
Authors: Shobhit Singla; Gabriella E Garcia; Grace E Rovenolt; Alexandria L Soto; Emily J Gilmore; Lawrence J Hirsch; Hal Blumenfeld; Kevin N Sheth; S Bulent Omay; Aaron F Struck; M Brandon Westover; Jennifer A Kim Journal: Curr Neurol Neurosci Rep Date: 2020-07-27 Impact factor: 6.030
Authors: Paul M Vespa; DaiWai M Olson; Sayona John; Kyle S Hobbs; Kapil Gururangan; Kun Nie; Masoom J Desai; Matthew Markert; Josef Parvizi; Thomas P Bleck; Lawrence J Hirsch; M Brandon Westover Journal: Crit Care Med Date: 2020-09 Impact factor: 9.296
Authors: Aaron F Struck; Andres A Rodriguez-Ruiz; Gamaledin Osman; Emily J Gilmore; Hiba A Haider; Monica B Dhakar; Matthew Schrettner; Jong W Lee; Nicolas Gaspard; Lawrence J Hirsch; M Brandon Westover Journal: Ann Clin Transl Neurol Date: 2019-06-27 Impact factor: 4.511