Neuroanesthesia & neurocritical care
Prognostic value of early early electroencephalogram (EEG) abnormalities in severe stroke patients requiring mechanical ventilation: a pre-planned analysis of the SPICE prospective multicenter study
Main finding · Unfavorable outcome at one yearResult — go to the resultOdds ratio 6.02 95% CI 2.27–15.99Authors' conclusion
The absence of EEG reactivity independently predicts unfavorable outcomes at one year in severe stroke patients requiring mechanical ventilation in the ICU, although its prognostic value remains limited. Conversely, a benign EEG pattern was associated with a favorable outcome.
Study context
- Population
- Adult stroke patients requiring invasive mechanical ventilation with ≥1 intermittent EEG during ICU stay, 33 intensive care units (ICUs), Paris area, France, 2017–2019of 364 enrolled in SPICE
- Participants
- 153 patients
- Exposure
- Unfavorable outcome vs Favorable outcome
- Outcome
- Functional neurological outcome (mRS), dichotomized as unfavorable (mRS 4-6) or favorable (mRS 0-3)
- Follow-up
- One year
Methodological detailspre-planned ancillary analysis of the SPICE study, multicentre, EEG at median 4 (IQR 2-7) days post-stroke; 49 ischemic strokes, 52 intracranial hemorrhages, 52 subarachnoid hemorrhages
- Pre-planned ancillary analysis of the SPICE study
- Multicentre
- EEG at median 4 (IQR 2-7) days post-stroke; 49 ischemic strokes, 52 intracranial hemorrhages, 52 subarachnoid hemorrhages
Main finding
Unfavorable outcome at one year
Odds ratio
6.02
95% CI 2.27–15.99
EEG abnormalities in patients with unfavorable vs favorable 1-year outcome
OR 6.02 (95% CI 2.27–15.99)
As reported in the abstract
- Unreactive EEG predicting unfavorable outcome: specificity
- 48% (95% CI 40-56)
- Unreactive EEG predicting unfavorable outcome: sensitivity
- 79% (95% CI 72-85)
- Unreactive EEG predicting unfavorable outcome: PPV
- 74% (95% CI 67-81)
- Benign EEG predicting favorable outcome: specificity
- 89% (95% CI 84-94)
- Benign EEG predicting favorable outcome: sensitivity
- 37% (95% CI 30-45)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Prevalence of EEG abnormalities by outcomeUnfavorable outcome vs Favorable outcome | Diffuse slowing 70% vs. 63% | P = 0.37 |
| Prevalence of EEG abnormalities by outcomeUnfavorable outcome vs Favorable outcome | Focal slowing 38% vs. 32% | P = 0.15 |
| Prevalence of EEG abnormalities by outcomeUnfavorable outcome vs Favorable outcome | Periodic discharges 2.3% vs. 3.7% | P = 0.9 |
| Prevalence of EEG abnormalities by outcomeUnfavorable outcome vs Favorable outcome | Electrographic seizures 4.5% vs. 3.7% | P = 0.4 |
Prevalence of EEG abnormalities by outcome
- Comparable between unfavorable and favorable outcomes
Original publication
Prognostic value of early EEG abnormalities in severe stroke patients requiring mechanical ventilation: a pre-planned analysis of the SPICE prospective multicenter study. Crit Care. Published 23 May 2024. doi:10.
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