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Use of EEG in critically ill children and neonates in the United States of America

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Abstract

The objective of the study was to estimate the proportion of patients who receive an electroencephalogram (EEG) among five common indications for EEG monitoring in the intensive care unit: traumatic brain injury (TBI), extracorporeal membrane oxygenation (ECMO), cardiac arrest, cardiac surgery and hypoxic-ischemic encephalopathy (HIE). We performed a retrospective cross-sectional descriptive study utilizing the Kids’ Inpatient Database (KID) for the years 2010–2012. The KID is the largest pediatric inpatient database in the USA and it is based on discharge reports created by hospitals for billing purposes. We evaluated the use of electroencephalogram (EEG) or video-electroencephalogram in critically ill children who were mechanically ventilated. The KID database had a population of approximately 6,000,000 pediatric admissions. Among 22,127 admissions of critically ill children who had mechanical ventilation, 1504 (6.8%) admissions had ECMO, 9201 (41.6%) TBI, 4068 (18.4%) HIE, 2774 (12.5%) cardiac arrest, and 4580 (20.7%) cardiac surgery. All five conditions had a higher proportion of males, with the highest (69.8%) in the TBI group. The mortality rates ranged from 7.02 to 39.9% (lowest in cardiac surgery and highest in ECMO). The estimated use of EEG was 1.6% in cardiac surgery, 4.1% in TBI, 7.2% in ECMO, 8.2% in cardiac arrest, and 12.1% in HIE, with an overall use of 5.8%. Among common indications for EEG monitoring in critically ill children and neonates, the estimated proportion of patients actually having an EEG is low.

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Authors and Affiliations

  1. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Marina Gaínza-Lein, Iván Sánchez Fernández & Tobias Loddenkemper

  2. Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile

    Marina Gaínza-Lein

  3. Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain

    Iván Sánchez Fernández

Authors
  1. Marina Gaínza-Lein
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  2. Iván Sánchez Fernández
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  3. Tobias Loddenkemper
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Correspondence to Tobias Loddenkemper.

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Conflicts of interest

Marina Gaínza-Lein is supported by the Epilepsy Research Fund. Iván Sánchez Fernández is funded by Fundación Alfonso Martín Escudero and the HHV6 Foundation. Tobias Loddenkemper serves on the Laboratory Accreditation Board for Long Term (Epilepsy and Intensive Care Unit) Monitoring, on the Council (and as Vice President) of the American Clinical Neurophysiology Society, on the American Board of Clinical Neurophysiology, as an Associate Editor for Seizure, as Contributing Editor for Epilepsy Currents, and as an Associate Editor for Wyllie’s Treatment of Epilepsy 6th edition. He is part of pending patent applications to detect and predict seizures and to diagnose epilepsy. He receives research support from the Epilepsy Research Fund, the American Epilepsy Society, the Epilepsy Foundation of America, the Epilepsy Therapy Project, PCORI, the Pediatric Epilepsy Research Foundation, CURE, HHV-6 Foundation, and received Research Grants from Lundbeck, Eisai, Upsher-Smith, Acorda, and Pfizer. He serves as a consultant for Zogenix, Upsher Smith, Lundbeck, and Sunovion. He performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies at Boston Children’s Hospital and affiliated hospitals and bills for these procedures and he evaluates pediatric neurology patients and bills for clinical care. He has received speaker honorariums from national societies including the AAN, AES and ACNS, and for grand rounds at various academic centers. His wife, Dr. Karen Stannard, is a pediatric neurologist and she performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies and bills for these procedures and she evaluates pediatric neurology patients and bills for clinical care.

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Gaínza-Lein, M., Sánchez Fernández, I. & Loddenkemper, T. Use of EEG in critically ill children and neonates in the United States of America. J Neurol 264, 1165–1173 (2017). https://doi.org/10.1007/s00415-017-8510-3

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  • DOI: https://doi.org/10.1007/s00415-017-8510-3

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