Implementation and Early Evaluation of a Quantitative Electroencephalography Program for Seizure Detection in the PICU*. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Rowberry, Tracey; Kanthimathinathan, Hari Krishnan; George, Fay; Notghi, Lesley; Gupta, Rajat; Bill, Peter; Wassmer, Evangeline; Duncan, Heather P.; Morris, Kevin P.; Scholefield, Barnaby R.
• Is Part Of: Pediatric critical care medicine. Volume 21:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: child -- electroencephalography -- intensive care units -- pediatric -- neurophysiology -- seizures -- status epilepticus; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000002278
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Objectives: To describe implementation and early evaluation of using quantitative electroencephalography for electrographic seizure detection by PICU clinician staff. Design: Prospective observational study of electrographic seizure detection by PICU clinicians in patients monitored with quantitative electroencephalography. Quantitative electroencephalography program implementation included a continuous education and training package. Continuous quantitative electroencephalography monitoring consisted of two-channel amplitude-integrated electroencephalography, color density spectral array, and raw-electroencephalography. Setting: PICU. Patients: Children less than 18 years old admitted to the PICU during the 14-month study period and deemed at risk of electrographic seizure. Interventions: None. Measurements and Main Results: Real time electrographic seizure detection by a PICU team was analyzed for diagnostic accuracy and promptness, against electrographic seizure identification by a trained neurophysiologist, retrospectively reading the same quantitative electroencephalography and blinded to patient details. One-hundred one of 1, 510 consecutive admissions (6.7%) during the study period underwent quantitative electroencephalography monitoring. Status epilepticus (35%) and suspected hypoxic-ischemic injury (32%) were the most common indications for quantitative electroencephalography. Electrographic seizure was diagnosed by the neurophysiologist in 12% ( n = 12) of the cohort. PICU clinicians correctly diagnosed all 12 patients (100% sensitivity and negative predictive value). An additional eleven patients had a false-positive diagnosis of electrographic seizure (false-positive rate = 52% [31–73%]) leading to a specificity of 88% (79–94%). Median time to detect seizures was 25 minutes (5–218 min). Delayed recognition of electrographic seizure (> 1 hr from onset) occurred in five patients (5/12, 42%). Conclusions: Early evaluation of quantitative electroencephalography program to detect electrographic seizure by PICU clinicians suggested good sensitivity for electrographic seizure detection. However, the high false-positive rate is a challenge. Ongoing work is needed to reduce the false positive diagnoses and avoid electrographic seizure detection delays. A comprehensive training program and regular refresher updates for clinical staff are key components of the program. Abstract : Supplemental Digital Content is available in the text.