EEG Monitoring in Critically Ill Children: Indications and Strategies

• Published in: Pediatric neurology 2012-03, Vol.46 (3), p.158-161
• Main Authors: Gutierrez-Colina, Ana M., Topjian, Alexis A., Dlugos, Dennis J., Abend, Nicholas S.
• Format: Article
• Language: English
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2011.12.009

Continuous electroencephalographic monitoring often detects non-convulsive seizures in critically ill children, but is resource intense and has not been shown to improve outcome. As institutions develop clinical pathways for monitoring, it is important to consider how seemingly minor variations may have a substantial impact on resource utilization and cost. We performed a one month prospective observational study in which each patient in a 45-bed pediatric intensive care unit was screened for potential monitoring indications. 247 patients were screened. Minor differences in monitoring indications would have a substantial impact on resource utilization. We then calculated the number of monitoring days that would be required each month based on two strategies that differed in monitoring duration. The prolonged-targeted and brief-targeted strategies would have required 106 and 33 monitoring days, respectively. Based on published non-convulsive seizure occurrence data, these strategies would detect 0.14, and 0.43 patients with seizures per monitoring day performed, respectively. A brief-targeted strategy provides a high yield for non-convulsive seizure identification, but would fail to diagnose some patients with seizures.