Time to electroencephalography is independently associated with outcome in critically ill neonates and children

Summary Objective To identify factors associated with in‐hospital mortality in neonates and children undergoing continuous electroencephalography (cEEG) monitoring in the intensive care unit (ICU). Methods We performed a retrospective observational study in patients from birth to 21 years of age who...

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Published in:Epilepsia (Copenhagen) 2017-03, Vol.58 (3), p.420-428
Main Authors: Sánchez Fernández, Iván, Sansevere, Arnold J., Guerriero, Rejean M., Buraniqi, Ersida, Pearl, Phillip L., Tasker, Robert C., Loddenkemper, Tobias
Format: Article
Language:English
Subjects:
Adolescent
Analysis of Variance
Child
Child, Preschool
Critical care
Critical Illness - mortality
Electroencephalography
Epilepsy
Female
Hospital Mortality
Humans
Infant
Infant, Newborn
Intensive Care Units
Male
Mortality
Outcome
Outcome Assessment (Health Care)
Pediatrics
Retrospective Studies
Seizures - physiopathology
Time
Time Factors
Young Adult
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Summary:Summary Objective To identify factors associated with in‐hospital mortality in neonates and children undergoing continuous electroencephalography (cEEG) monitoring in the intensive care unit (ICU). Methods We performed a retrospective observational study in patients from birth to 21 years of age who underwent clinically indicated cEEG in the ICU from 2011 to 2013. The main outcome measure was in‐hospital mortality. Results Six‐hundred and twenty‐five patients (54.2% male) met eligibility criteria, of whom 211 were neonates (55% male, 24.8% premature) and 414 were pediatric patients (53.9% male). Electrographic seizures occurred in 176 patients (28.2%) and status epilepticus (SE) occurred in 20 (11.4%). The time from ICU admission to cEEG initiation was 16.7 (5.1–94.4) h. Eighty‐nine patients (14.2%) (30 [14.2%] neonates, and 59 [14.3%] pediatric patients) died in the hospital. In neonates—after controlling for gender and prematurity—independent factors associated with mortality were prematurity (odds ratio [OR] 2.63. 95% confidence interval [CI] 1.06–6.5, p = 0.037), presence of status epilepticus (SE); OR 8.82, 95% CI 1.74–44.57, p = 0.008), and time from ICU admission to initiation of cEEG (OR 1.002, 95% CI 1.001–1.004 per hour, p = 0.008]. In pediatric patients—after controlling for gender and age—independent factors associated with mortality were the absence of seizures factors associated with mortality were absence of seizures (OR = 4.3, (95% CI: 1.5–12.4), p = 0.007), the presence of SE (OR 7.76, 95% CI 1.47–40.91, p = 0.016), and the time from ICU admission to initiation of cEEG (OR 1.001, 95% CI 1.0002–1.001, per hour, p = 0.005]. Significance Both presence of electrographic SE and time from ICU admission to cEEG initiation were independent factors associated with mortality in neonates and pediatric patients with cEEG in the ICU.
ISSN:0013-9580
1528-1167
DOI:10.1111/epi.13653