Neuroanesthesia & neurocritical care
Clinical and Electroencephalographic Predictors of Seizures and Status Epilepticus in 12,450 Critically Ill Adults: A Retrospective Cohort Study
Authors' conclusion
Using the largest existing cEEG database, we identified specific predictors of SE (cardiac arrest, clinical seizures prior to cEEG, brain neoplasms, LPDs, GPDs, and BIRDs) and seizures (all previous and LRDA).
Study context
- Population
- Adult hospitalized patients undergoing continuous EEG (cEEG) monitoring, Critical Care EEG Monitoring Research Consortium database, tertiary-care hospitals (February 2013 to June 2021)mean age 60 ± 17 yr
- Participants
- 12,450 participants
- Outcome
- Ordinal outcome: no seizures, isolated seizures without SE, or status epilepticus (SE)
- Follow-up
- First 72 hours of cEEG
Methodological detailsmulticentre registry
- Multicentre registry
Main finding
As reported in the abstract
Factors independently associated with SE (% with SE; aOR [CI])
- AnySz (isolated seizures or SE)
- 1,226 patients (9.8%)
- SE
- 439 patients (3.5%)
- Cardiac arrest: 9.2% with SE; aOR
- 8.8 [6.3-12.1]
- Clinical seizures before cEEG: 5.7% with SE; aOR
- 3.3 [2.5-4.3]
- Brain neoplasms: 3.2% with SE; aOR
- 1.6 [1.0-2.6]
- Lateralized periodic discharges (LPDs): 15.4% with SE; aOR
- 7.3 [5.7-9.4]
- Brief potentially ictal rhythmic discharges (BIRDs): 22.5% with SE; aOR
- 3.8 [2.6-5.5]
- Generalized periodic discharges (GPDs): 7.2% with SE; aOR
- 2.4 [1.7-3.3]
Observational data: associations, not effects.
Further findings
Factors associated with AnySz
- All SE predictors and lateralized rhythmic delta activity (LRDA) also associated with AnySz
Odds of SE over isolated seizures
- Cardiac arrest
- 7.3 [4.4-12.1]
- Clinical seizures
- 1.7 [1.3-2.4]
- GPDs
- 2.3 [1.4-3.5]
- LPDs
- 1.4 [1.0-1.9]
- LRDA (lower odds of SE vs isolated seizures)
- 0.5 [0.3-0.9]
RPP modifiers for SE prediction beyond RPP presence/absence
- Did not improve SE prediction
- P = 0.8
Original publication
Clinical and Electroencephalographic Predictors of Seizures and Status Epilepticus in 12,450 Critically Ill Adults: A Retrospective Cohort Study. Crit Care Med. Published 3 April 2023. doi:10.
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