Assistant Professor University of Wisconsin-Madison, United States
Introduction: Delays in status epilepticus diagnosis and treatment has been associated with poor health outcomes (Hill et al., 2017), and point-of-care EEG (POC EEG) has shown to shorten time to EEG and triage in critically-ill patients (Vespa et al., 2020). We hypothesize that patients who received POC EEG instead of or before conventional EEG (convEEG) would have an overall shorter length of stay (LOS) in the intensive care unit (ICU), potentially due to faster triage.
Methods: Data were collected in a multicenter retrospective study (SAFER EEG), where adult patients from 4 academic centers were: monitored with convEEG only, POC EEG only, and POC EEG followed by convEEG. We included patients who were admitted to the ICU and started an EEG study before ICU discharge. First, we compared ICU LOS in sites that had access to both POC EEG and convEEG. Second, we compared ICU LOS in a site with only convEEG and compared it to the subgroup of POC EEG followed by convEEG. Last, we performed subanalyses in patients with diagnosed seizures, in those who survived their ICU stay, and in those for whom EEG was started in non-working hours (i.e., after-hours).
Results: Records from 657 patients were included in the analysis (convEEG = 436, POC EEG = 221). In sites with POC EEG and convEEG available, we found that ICU LOS in the POC EEG groups was significantly lower than convEEG group (medianPOC-EEG = 4.5 [2.2, 11.0] d vs.mediancEEG = 8.0 [3.0, 16.9] d; p = 0.011).
In the site with only convEEG, we observed a significantly longer ICU LOS than in the cohort of POC EEG followed by convEEG (mediancEEG = 6.7 [3.4, 12.4] d, medianPOC-cEEG = 4.5 [2.4, 10.9] d; p = 0.006).
In both settings, a majority of the sub-analyses in patients who survived their ICU stay, those with diagnosed seizures, and those for whom EEG was started after-hours showed significantly lower ICU LOS in groups receiving POC EEG.
Conclusions: Patients who first received a POC EEG had, as a group, shorter ICU LOS when compared to those who received convEEG only. Multiple sub-analyses demonstrated the same trend across different centers. These data highlight that even in hospitals with 24/7 convEEG coverage, POC EEG can aid in patient assessment and early seizure detection, and can significantly shorten ICU stay.
